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MANUAL 



GENERAL, DESCRIPTIVE, AND PATHOLOGICAL 

ANATOMY, 

BY "^ 

J. F. MECKEL, 
•*♦ 

Professor of Anatomy at Halle, &x. &c. &c. 

TRANSLATED FROM THE GERMAN INTO FRENCH, 

WITH ADDITIONS AND NOTES, 

BY 

A. J. L. JOURDAN, 

Member of the Royal Academy of Medicine at Paris, &c. &c. &c. 
AND 

G. BRESCHET, 

Adjunct Professor of Anatomy at the School of Medicine, &c. &c. &«: 
TRANSLATED FROM THE FRENCH, 
WITH NOTE S,/ 

BY A. SIDNEY DOANE, A.M., M, D. 



IN THREE VOLUMES. 
VOLUME II. 



lit 4 " 



PHILADELPHIA 

CAREY & LEA.— CHESTNUT STREET 
1832. 






"Entered according to an act of Congress, in the year 1833, to Hon C .Sleight, in the 
office of to Clerk of the District Court of the Southern District of New Yo.k.' 



SI.EIGHT AND ROBINSON, PRIH 
No ill Nassau St., New York. 



MANUAL 

OP 

GENERAL, DESCRIPTIVE, AND PATHOLOGICAL 

ANATOMY. 



DESCRIPTIVE ANATOMY. 



BOOK II, 



OF SYNDESMOLO.GY. 

§ 818. Under the head of Syndesmology(l) we shall describe only the 
modes of union between the bones and the cartilages which cover their 
extremities. The connections between other organs, as the muscles 
and the viscera, will be mentioned when speaking of those organs. 

The bones are connected by very different substances, and the 
degree of motion between the bones which are united varies exceed- 
ingly. Descriptive syndesmology however treats of the two classes of 
ligaments, the synovial or capsular (§ 367), and the fibrous or accessory 
(§299). 

As these organs are intimately connected with the bones, it will be 
better to describe them in the same order. Hence we shall mention, 
first, the ligaments of the trunk, then those of the head, and conclude 
with those of the extremities. 



SECTION I. 

OF THE LIGAMENTS OF THE TRUNK, 

§ 819. The ligaments of the trunk arc divided into those of the ver- 
tebral column, of the ribs, and of the sternum. 

(1) The principal bocks of reference are, J. Weitbre< ht, Syndesmologia, sen Ws- 
toria ligamentorum corporis humani, Petereburgb, 1742. — Uesmogrdphie, ou De- 
scription des ligamens du corps humain, Paris, 1752. — M. Alberti, iSid-liche Lehre 
von der Ariiculation.cn des mcnschlichcn Korpcrs, Freyberg, 1745. 

Vol. II. 2 



10 DESCRIPTIVE ANATOMY. 

CHAPTER I. 

LIGAMENTS OF THE VERTEBRAL COLUMN. 

§ 820. The vertebrae are attached to one another in all parts of 
their surfaces by fibrous or fibro- cartilaginous ligaments, and in some 
parts by capsular ligaments also ; the former serve to retain these 
bones in their places and to confine their motions, while the latter faci- 
litate their motions, but are also covered externally by fibrous liga- 
ments". 

The principal ligaments of the vertebral column are, 1st, the inter- 
vertebral fibro-cartilages, which are of all the modes, the strongest 
bonds of union ; 2d, the synovial capsules, situated between the arti- 
cular processes and which facilitate their motions. 

These two kinds of ligaments are strengthened, as in all parts, by 
fibrous fasciculi, placed directly upon them, or which are attached to 
the other parts of the vertebral column. These fasciculi are the ante- 
rior and the posterior vertebral ligaments, the accessory fibres of the 
capsular ligaments, the yellow ligaments, the interspinal, and the 
intertransverse ligaments. 

We had better consider first the fibrous and fibro-cartilaginous liga- 
ments, and then the synovial capsules. 

I. FIBROUS AND FIBRO-CARTILAGINOUS LIGAMENTS. 

I. BETWEEN THE BODIES OF THE VERTEBRJE. 

A. ANTEHIOB VEBTEBBAL LIGAMENT. 

§ 821. The anterior vertebral ligament (fascia longiludinalis ante- 
rior, ligamentum corporibus vertebrarum commune anterius) covers the 
anterior and convex face of the bodies of the vertebrae. It extends 
from the centre of the anterior part of the large occipital foramen 
which Weitbrecht has wrongly disputed, to the last bone of the coccyx. 

It is composed of longitudinal fibres which do not extend uninter- 
ruptedly from one extremity of the column to the other, but cover in 
fact only a single vertebra, and which unite above and below on the 
surface of the intervertebral ligaments with those of the adjacent 
vertebrae. 

The fibres are thicker on the vertebra than in any other part ; they 
grow thinner and shorter as they approach the upper and lower faces of 
the bone. Hence the anterior surface of the vertebral column is more 
uniformly convex than it would be without this arrangement, since the 
bodies of the vertebrae are concave from above downward. 

Besides the straight fibres, we also find many which are oblique • 
these cross the former at a very acute angle. 



STNDESMOLOGY. 11 

This ligament is thicker, and its fibres are much closer in its centre 
than on the sides'. The fibres separate very much from each other on 
the two sides of the median line, while on the contrary they unite 
backward so that they form three bands, the central of which is the 
strongest while the two lateral bands are weaker. 

The ligament covers all the anterior face of the bodies of the verte- 
brae ; it is not confined to the centre and to sending only irregular 
prolongations to the sides. Its lateral parts are composed of longitu- 
dinal fibres as regular as those of' the central portion ; and they differ 
so little in their essential characters from the periosteum, that the liga- 
ment may be regarded as a periosteum more developed. We cannot at 
least refuse it this character in most of the vertebral column, especially 
in the dorsal, the lumbar, the sacral, and the coccygeal regions. In the 
cervical vertebrae, especially the upper two, the anterior ligament assumes 
still more the appearance of a very thick, rounded, and very projecting 
band, which covers only the centre of the anterior face, while the fibres 
on the lateral parts of the bodies are thin and irregular. This differ- 
ence doubtless exists because the anterior face of the cervical region 
is covered with muscles, which are not found in the other regions of 
the vertebral column. The lateral part of the anterior ligament in 
these last, appears in the neck as the tendons of the anterior muscles 
of the neck. So too on the second lumbar vertebra, this ligament 
becomes the tendons of the diaphragm. 

The narrowness of the anterior ligament on the upper cervical ver- 
tebras depends upon the great degree of motion possessed by these 
bones, and being formed in this manner their motions are not so much 
obstructed. 

This ligament is not equally thick on all the vertebrae. Its thickest 
parts cover the upper cervical and dorsal vertebrae, the thinnest are 
found on the superior lumbar vertebrae. 

It not only unites the bodies of the vertebrae forward, but also pre- 
vents the column from bending too much backward. 

B. POSTERIOR VERTEBRAL LIGAMENT. 

§ 822. The posterior vertebral ligament (fascia, s. ligamentum 
commune ^osterius) extends along the posterior face of the bodies of 
the vertebrae, within the medullary canal. ^ 

It diminishes in breadth from above downward ; in the cervical ver- 
tebra it is as broad as the bodies of the vertebrae ; it is much thinner 
on the sides in the dorsal vertebrae, and finally disappears entirely in 
the lumbar regions, becoming a single waving band situated on the 
median line, being a little broader on a level with the upper and lower 
faces of the bodies of the vertebrae. 

A' the same time, it is attached to the intervertebral substance more 
firmly than to the posterior face of the bodies of the vertebrae. 



12 DESCRIPTIVE ANATOMY. 

Its relations with the vertebrae and with the dura mater arc not ex- 
actly the same. In most of the vertebral column it is intimately 
connected with the bodies of the vertebrae, and it is attached to the dura 
mater only by a loose mucous tissue. But, at the third cervical verte- 
bra its relations with these vertebrae change, since the ligaments ex- 
tending from the head to the cervical vertebrae form, between it and 
their posterior faces, a peculiar fibrous mass, the fibrous mass between 
the head and the cervical vertebrae, to which that ligament adheres 
but very slightly as far as the upper extremity of the vertebral column. 

In its first portion, it unites as usual to the dura mater ; but at the 
upper extremity of the vertebral column it is so closely connected with 
this membrane that some skill is required to separate them ; hence 
the separation between the fibrous membrane of the central portions 
of the nervous system and the largely developed periosteum of the 
vertebrae begins in this place. 

In the same place the posterior vertebral ligament unites intimately 
with the fibrous mass between the head and the cervical vertebrae. 

This ligament limits, to a certain extent, the flexion of the vertebral 
column forward. 

C. INTERVERTEBRAL LIGAMENTS. 

§ 823. The intervertebral ligaments (Lig. intervertebralia) are the 
principal means of uniting the bodies of the vertebrae, and the verte- 
brae generally ; for the attachments of these bones in other parts, are 
much looser and much less extensive. 

These ligaments completely fill the spaces between the bodies of 
the vertebrae ; they form layers, the upper and lower faces of which 
are attached to the corresponding faces of two superimposed vertebrae. 

They are formed of a considerable number of perpendicular and 
almost concentric layers, shaped like the circumference of the upper 
and lower faces of the vertebrae, and they are consequently annular. 
Their two edges are attached to the two faces of the vertebrae. Their 
layers are evidently fibrous ; in the external layers the fibres are 
oblique, and almost horizontal in the internal. The oblique fibres of 
the external layers cross at acute angles. The layers adhere very 
firmly together by the fibres which extend from one to the other ; hence 
they form ofcly a single dense scaly tissue. 

Between the layers we find a softer, yellowish, gelatinous, and 
shapeless mass. 

The nature, the relations, and the proportional quantity of these two 
substances, differ in all parts of the ligament. 

In the circumference, and especially in its anterior portion, the layers 
much exceed the intermediate substance ; they are very compact and 
are evidently fibrous. Internally, they are rrmch softer ; they sepa- 
rate from each other and finally disappear entirely, so that the 
nucleus, formed by the gelatinous substance, only remains. In what- 



STNDESMOLOGY. 13 

ever direction the vertebral ligaments are cut, this nucleus projects from 
the incision, being pushed out by the elasticity of the fibrous layers. 

These ligaments are thicker in the centre than on the circumference, 
because the bodies of the vertebra are concave in this place. 

They are very solid, so that the bones of the vertebral column will 
break before they tear. 

From their great elasticity, the height of man varies at all periods 
of life, and diminishes or increases according as the vertebral ligaments 
have been for a longer or shorter time pressed down by the weight of 
the head and that of the vertebrae upon each other ; hence man is 
taller in the morning than at night. This difference is not the same 
at all ages ; it is less evident in old than in young men. In general it 
amounts to about one inch.(l) 

The intervertebral ligaments have not the same thickness in all 
parts. It diminishes from the cervical vertebrae to the lower extremity 
of the vertebral column, whence there is a difference in this respect of 
several lines. Between the lumbar, these ligaments are only three or 
four lines thick. 

§ 824. There are no intervertebral ligaments between the first and 
second cervical vertebrae, nor between the first and the head, between 
the sacrum and the coccyx, nor between the bones of the coccyx ; 
these bones are united in a looser manner. 

§ 825. The intervertebral ligaments are strengthened directly by 
anterior and posterior vertebral ligaments (§ 822, 823), which cover 
most of their circumference, and pass before them in going from one 
vertebra to another. 



II. OF THE FIBROUS AND FIBROCARTILAGINOUS LIGAMENTS BETWEEN THE 
ARCHES AND THE PROCESSES. 

A. 1ELLOW LIGAMENTS. 

§ 826. The arches of the vertebras are united by the yelloiv liga- 
ments (Lig- crurum vel arcuum subjiava, s.fluva), as their bodies are 
connected by the intervertebral ligaments. These two kinds of liga- 
ments may then be compared to each other. 

The yellow ligaments are yellowish, lustreless, and smooth ; they 
are formed of several perpendicular and very elastic fibres, of which 
the external are evidently of a tendinous nature. These external 
fibres, which have a more oblique direction, fill all the space between 
the arches of two adjacent vertebras, from the roots of the transverse 
processes to the angle of union, which however remains unattached. 

Their upper edge is always attached to the internal face, and never 
to the inferior edge of the arch of the vertebra above. The inferior 
is attached to the upper edge, and slightly to the external face of the 

(1) Mem. dc Paris, 1725, 1730. 



14 DESCRIPTIVE ANATOMY. 

arch of the vertebra below. The vertebra; are rough where these liga- 
ments are inserted. 

The thickness, solidity, and elasticity of these ligaments are very 
considerable. 

They fix the extent of flexion forward and backward in the vertebral 
column. 

They are not perfectly similar in all parts. of the spinal column. 
The smallest are in the dorsal region, those in the neck are larger, and 
the largest in the lumbar region. Those in the lumbar region are the 
thickest, and the thinnest are those of the cervical region. Their 
insertions also vary in extent in the different regions ; in the neck they 
are attached by a thin upper edge to a very narrow portion of the 
internal face of their archss, above their inferior edge. In the back 
and loins, this portion is a very broad surface, almost as high as the 
ligaments, and extends from the centre of the arches to their inferior 
edge.(l) These differences are worthy of remark, first, because ana- 
tomists have hitherto neglected the second ; secondly, because they 
serve to increase the power of the lower portions of the vertebral 
column and the mobility of its upper portions. 

The yellow ligaments do not exist between the first and the second 
cervical vertebra, nor between the first cervical vertebra and the 
occipital bone, or at least they are developed very feebly in these two 
parts. 

B. INTERSPINAL MEMRRANES AND SUPRASPINAL LIGAMENTS. 

§ 827. Between the spinous processes we find two kinds of fibrous 
ligaments, the interspinal membranes (membranes, interspinales) , and 
the supraspinal ligaments (Lig. inter apices processuum spinosorum). 

a. Interspinal membranes. 

§ 828. The interspinal membranes are thin and broad, and are formed 
of irregular, and generally of horizontal fibres. They extend from the 
roots of the spinous processes to near their summits. They limit flexion 
forward and are destined especially for the insertion of the long mus- 
cles of the back. 

b. Supraspinal ligaments. 

§ 829., The supraspinal ligaments are small rounded bundles of 
longitudinal fibres, which attach the summits of the spinous processes 
of the vertebrae to each other, so as to form in fact but one ligament. 
They also serve to limit flexion forward. 

(1) Weitbrecht is mistaken in saying- of these ligaments (loc. cit pa"-e 107) Mar 
gincs prcedictorum crurum vi.v sensibiliter superscandunt, since they are everv ■'where 
attached much higher than the luwer edge, and none of their fibres are inserted in 
the vertebrae of the neck. u "* 



SYNDESMOLOGY. 15 



C. INTERTRANSVERSE LIGAMENTS. 



§ 830. The intertransverse, ligaments (Lig. recta processutnn trans- 
versalium vertebrarum, s. interlransversaria) do not every where exist. 
They are found only between the transverse processes of the inferior 
dorsal vertebrae forward. They serve not so much to unite the verte- 
brae as to multiply the points of attachment for the sacro-lumbalis and 
the levatores costarum muscles. 

II. CAPSULAR LIGAMENTS. 

§ 831. We find on each side, between every two vertebra, a capsu- 
lar ligament, the ligament of the articular processes {Lig. capsulare 
processum obliquorum) ; this arises from the circumference of the articu- 
lar faces of the adjacent oblique processes by irregular bundles of fibres. 
In the dorsal and lumbar regions this ligament is strengthened ante- 
riorly by the yellow ligaments. 

These ligaments have not the same extent in every part. They 
are much looser and less tense in the neck than in the other parts of 
the vertebral column. The broadest, the thinnest, and the loosest, is 
that between the first and second cervical vertebrae. 



CHAPTER II. 

OF THE LIGAMENTS OF THE RIBS. 

§ 832. The ligaments of the ribs are divided into three classes : 
1st. Those situated between the ribs and the vertebrae. 
2d. Those situated between the ribs and the sternum. 
3d. Those which exist between the ribs. 

I. LIGAMENTS BEWEEN THE RIBS AND THE VERTEBRiE. 

§ 833. The ligaments between the ribs and the vertebra, are some 
of them synovial capsules, and others supplementary fibres, which 
unite the posterior parts of the ribs with the bodies and the transverse 
processes of the vertebrae. 

A. LIGAMENTS OF THE HEADS OF THE BIBS. 

§ 834. The ligaments of the heads of the ribs {Lig. capitulorum 
costarum) are short capsules, which extend from the lateral articular 
facets of the dorsal vertebrae to the heads of the ribs. These capsules 
are strengthened in front by the oblique fibrous ligaments, which 
have two different directions ; the upper go from within outward, and 
from above downward, and the inferior in the opposite.direction. 



16 DESCRIPTIVE ANATOMF. 



B. LIGAMENTS OF THE TUBERCLE, AND THE EXTERNAL TRANSVERSE LIGA- 
MENTS OF THE RIBS. 

§ 835. Short synovial capsules arise from the anterior face of the 
summits of the transverse processes of the dorsal vertebrae, and go to 
the circumference of the articular surface of the tubercles. These 
capsules are looser in the lower than in the upper ribs. 

The quadrangular ligaments (ligamenla Iransversaria costarum 
externa) are situated on them posteriorly, and proceed from the summits 
of the transverse processes of the vertebras : they are formed of very 
strong, more or less transverse fibres. These ligaments are narrower 
from above downward than from without inward, and are longer in the 
inferior than in the superior vertebrae. Their fibres descend to the 
upper and ascend to the lower ribs, from the transverse processes of the 
vertebrse. 

They serve to strengthen the articulations of the ribs with the 
vertebrae. 

C. INTERNAL LIGAMENTS OF THE NECKS OF THE RIBS. 

§ 836. The internal ligaments of the necks of the ribs, or the in- 
ternal transverse ligaments (Lig. cervicis costarum interna s. irans- 
versaria interna) do not extend, like the former, from the vertebras to 
the ribs, which are articulated with them ; but from the inferior edge 
of the transverse process of the vertebra above, to the neck of the rib 
below. They are formed of fibres, which proceed obliquely from above 
downward, and from without inward. Their form is rhomboidal, and 
they are thinner and more feeble than the former. 

D. EXTERNAL LIGAMENTS OF THE NECKS OF THE RIBS. 

§ 837. The external ligaments of the necks of the ribs {Lig. costarum 
cervicis externa) are situated opposite the internal, and are composed of 
fibres which proceed in an opposite direction, and also extend from the 
transverse processes of the vertebrae to the necks of the ribs next 
below. They are scarcely apparent, or in fact do not exist, between 
the two upper and the two lower ribs. 

E. ACCESSORY LIAGMENTS OF THE RIBS. 

§ 838. The accessory ligaments of the ribs (Lig. accessoria cos- 
tarum) are rounded bands situated beyond the articular heads, which, 
descend from the transverse processes of the vertebrae to the posterior 
extremities of the bodies of the ribs. 

II. COSTO-STERNAL LIGAMENTS. 

§. 839. The ribs unite to the sternum by the costal cartilages, in 
part directly, in part indirectly. 



» SYNDESMOLOGY. 17 

The cartilage of the first rib is attached to the handle of the sternum, 
and those of the other six true libs unite to the articular depressions of 
this bone by very short capsular ligaments, on which pass strong 
tendinous fibres united to the periosteum. These ligaments radiate 
and extend very far, particularly on the anterior face of the body, so 
that those of one side intercross with those of the side opposite. 

III. INTERCOSTAL LIGAMENTS. 

§ 840. If we except some tendinous fasciculi of the intercostal 
muscles which are situated between the bony portions of two adjacent 
ribs, and which are continuous posteriorly with the intertransverse 
ligaments of the vertebra (§ 830), only the costal -:cartilages are 
united by particular and constant ligaments. These ligaments are 
arranged in two different ways. 

A. ARTICULAR LIGAMENTS OF THE COSTAL CARTILAGES. 

§ 841. The fifth, sixth, seventh, and eighth costal cartilages are 
un i by synovial capsules, on which are strong fibres passing ob- 
liquely from above downward, and from without inward. Instead of 
these capsules, we find between the two following ribs only short 
tendinous fibres ; and between the last ribs only the fibres of the inter- 
costal muscles, and of th^obliqui abdominis muscles. 

B. FIBROUS LIGAMENTS OF THE COSTAL CARTILAGES. 

§ 842. Narrower fibrous ligaments (Lig. coruscantia) are situ- 
ated perpendicularly or obliquely from above downward, and from 
without inward. They proceed forward, rarely backward, and unite 
together the costal cartilages, beginning with that of the third rib, 
except those of the four mentioned in the paragraph above. 

CHAPTER III. 

OF THE LIGAMENTS OF THE STERNUM. 

§ 843. Between the three pieces of the sternum is a fibro-cartila- 
ginous mass formed of horizontal fibres, which go from before back- 
ward. This mass seldom disappears entirely, and never except at a 
very advanced age ; but it is effaced between the second and the third 
pieces more frequently than between the first and second. It may be 
compared with the intervertebral cartilages (§ 823). 

On its surface, and also on the anterior and the posterior face of the 
sternum, are expanded firm tendinous bands, which unite to form 
membranous expansions termed the anterior and posterior sternal 
membranes (membrana ossium sterni anterior et posterior) . 

Vol. II. 3 



18 DESCRIPTIVE ANATOMV. 

The posterior sternal membrane is formed almost entirely of perpen- 
dicular fibres, which are connected with the fibrous bands coming from 
the membrane of the costal cartilages, at the place where the latter 
unite to the sternum. 

In the anterior sternal membrane, on the contrary, we see only at 
its inferior portion and on the median line, a narrow band formed of 
longitudinal fibres which arise from the fibres of the membrane of the 
cartilages of the inferior true ribs. Most of its fibres are formed of fan- 
like expansions, the summits of which correspond to the insertions of 
the costal cartilages in the sternum, and intercross with those of the 
posterior face of the sternum, partially covering the longitudinal fibres 
from the same origin, and partly covered by them. 

These two sternal membranes evidently correspond to the two 
ligaments of the vertebral column (§ 821,822). They should then, 
from analogy, be called the sternal ligaments. 



SECTION II. 

OF THE LIGAMENTS OF THE HEAD. 

§ 844. The ligaments of the head are, 

1st. The ligaments which unite the head to the vertebral column. 

2d. The ligaments of the lower maxillary bone. 

CHAPTER I. 

OP THE LIGAMENTS BETWEEN THE HEAD AND THE VERTE- 
BRAL COLUMN.(l) 

§ 845. The head and particularly the occipital bone considered as 
a single bone articulated to the vertebral column, unites with the first 
and second cervical vertebrae, and with each differently. The pecu- 
liarities of the articulations between the first and second cervical 
vertebrae, have determined us to examine them separately and to 
describe them apart from the general ligaments of the vertebral 
column. 

1. LIGAMENTS BETWEEN THE OCCIPITAL BONE AND THE ATLAS. 

§ 846. The connection between the occipital bone and the atlas is 
less intimate than between the vertebrae. The intervertebral and the 
yellow ligaments do not exist ; they are, like the fibrous ligaments, 
replaced only by looser fibrous bands, which extend from the anterior 
and posterior arches to the large occipital foramen, and are called the 
occipilo-alloidal membranes. 

(1) Mauchart, resp. Rumelin, Capitis articulatio cum prima et sccunda colli ver- 
tebra, Tubingen, 1747. 



SYNDESMOLOGY. 19 



I. ANTERIOR OCCIPITO-ATLOIDAL MEMBRANE. 

§ 847. The anterior occipilo-atloidal ligament (membrana annuli 
anterioris atlantis) is, in fact, only the summit of the anterior vertebral 
ligament, and extends from the anterior arch of the atlas to the anterior 
edge of the large occipital foramen. It is formed of perpendicular 
fibres, of which those in the centre are stronger, and form a distinct and 
projecting fasciculus, which is continuous with the central and pro- 
minent portion of the anterior vertebral ligament (§821), and is attached 
to the centre of the basilar process of the occipital bone. 

II. POSTERIOR OCCIPITO-ATLOIDAL MEMBRANE. 

§ 848. The posterior occipito-atloidal membrane (membrana annuli 
posterioris atlantis) is situated between the posterior extremities of the 
two articular ligaments, and extends from the upper edge of the 
posterior arch to the posterior part of the circumference of the occipital 
foramen, and fills the posterior space between the two bones. It is 
thinner and weaker than the anterior, and does not form a continuous 
membrane, as that does. ' 

III. ARTICULAR LIGAMENTS. 

§ 849. The. articular processes of the occipital bone and of the atlas 
are united, like the articular surfaces of the transverse processes, by a 
complete capsular ligament (Lig. articulationum capitis cum atlante, 
Lig. articulare superius), which arises from the circumference of their 
contiguous surfaces. It differs from the others in being broader and 
looser, so that it allows more extensive motions. . 

IV. ACCESSORY LIGAMENTS. 

§ 850. The accessory ligaments (Lig. accessoria) are fibrous bands, 
which proceed obliquely from above do wn ward , and from without inward, 
from the summit and from the upper edge of the transverse processes 
of the atlas, and are attached partly to the capsule and partly to the 
occipito-atloidal membranes, and around the occipital foramen. They 
strengthen the ligaments already described, and furnish points of 
attachment to the small deep muscles of the head. 

H. LIGAMENTS BETWEEN THE BASILAR BONE AND THE AXIS. 

§ 851. The union between the head and the axis by means of the 
basilar bone is much firmer and stronger than that between the head 
and the atlas. It is formed by very dense bands of longitudinal fibres, 
which extend from the edges of the occipital foramen to the centre of 
the axis. There are no capsular ligaments in this articulation. 



20 DESCRIPTIVE ANATOMV. 



I. SUSPENSORY LIGAMENT OF THE SECOND CERVICAL VERTEBRA. 

§ 852. The middle straight ligament, or the suspensory ligament of 
the second cervical vertebra(l) (Lig. suspensorium dentis epistrophei, s. 
rectum medium), is oblong and composed of straight fibres. It extends 
from the centre of the anterior edge of the occipital foramen to the sum- 
mit of the odontoid process, to which it is attached directly above the 
small anterior articular fossa. It prevents the head from turning too 
far backward. 

II. LATERAL LIGAMENTS OF THE SECOND CERVICAL VERTEBRA. 

§ 853. The lateral ligaments of the second cervical vertebra (Lig. 
epistrophei lateralia, s. alaria Maucharti) are one on each side, and 
arise some lines behind the suspensory ligament, from the anterior part 
of the lateral region of the occipital foramen, and from the rough fossa 
situated above the internal edge of the condyles of the occipital bone. 
Their fibres are oblique and are attached to the lateral edges of the 
odontoid process. 

When the head is turned to one side the fibres of the lateral ligament 
of the opposite side are tense ; so that these ligaments limit the lateral 
motions of the head. 

These three ligaments are the most important of those which unite 
the head with the first cervical vertebra. If one or all three of them 
be torn, the odontoid process is displaced by the least exertion, slips 
into the vertebral canal, suddenly compresses the origin of the spinal 
marrow, and thus occasions death. Hence death from hanging, and 
hence too, when the head is quickly turned to the side, or when it exe- 
cutes similar motions, the subject sometimes dies. 

III. COMMON LIGAMENTS BETWEEN THE BASILAR BONE AND THE 
CERVICAL VERTEBRjE. 

§ 854. The common ligaments between the basilar bone and the 
cervical vertebrae are of several kinds, and differ in form, situation, and 



(1) Soemmerring (Banderlehre, p. 17) has already remarked that Weitbrecht was 
wrong in denying- the existence of this ligament. In fact, we have always found it 

Eerfectly distinct from the crucial ligament; so that, we cannot agree with VVeit- 
recht in thinking that anatomists have been induced by this branch to admit its 
existence, since we have found both of them constantly, and they were separated by 
a loose cellular tissue. This remark might seem superfluous, if Bichat had not 
adopted Weitbrecht'p opinion. True, he describes a special ligament between the 
middle of the odontoid process and the basilar bone, but he is mistaken in statins it 
to be formed by the upper branch of the crucial ligament and the suspensory liea 
ment; so that he describes the crucial Ligament as formed only uf a transverse Dart 
and of the lower branch, and even mentions a connection between its fibre* and those 
of the posterior ligaments of the vertebra;, although in fact they are separated by the 
capsule of the crucial ligament (§ So/). ' ' 



SYNDESMOEOGY. 21 

extent. We may divide them into those which are situated within and 
those which are placed on the outside of the vertebral column. 

I. COMMON INTERNAL LIGAMENTS. 

A. CRUCIAL LIGAMENT. 

§ 855. Behind the ligament described we find another, which is 
weaker, called the crucial ligament {Lig- cruciforme). It is also called 
the transverse ligament of the atlas (L. atlantis transversale)] this term is 
however improper, as it points out only one of its parts. It unites the 
basilar bone with the first two cervical vertebrae. 

Its strongest transverse part, called the transverse ligament of the 
atlas, is formed of transverse fibres. It is attached by its two extremi- 
ties to the rough lateral edge of the medullary foramen of the atlas. It 
is very tense, and is situated behind the odontoid process : it is much 
broader in the centre than at its two extremities, and it is cartilaginous 
forward on the side of the posterior face of the odontoid process. Mau- 
chat has noticed this peculiarity, but he adds, that in this part the liga- 
ment does not adhere to the process but is only in contact with it. 
Bichat only has described the connection of this cartilaginous portion 
with the process ; he states that a synovial capsule exists between 
them. In fact we have constantly observed this capsule, which we 
have always found also very broad and very loose. 

This transverse ligament forms the two horizontal branches of the 
cross. The two perpendicular branches of the cross, the upper and 
the lower, called also the appendages (apjjendices), arise from its centre ; 
these are much weaker and are both formed of longitudinal fibres. 

The upper branch is much longer than the lower, becomes much 
broader upward, and is not only attached behind the suspensory liga- 
ment, from which it is evidently distinct at the centre of the occipital 
foramen, but also extends some lines on the centre of the upper face of 
the basilar process of the occipital bone. 

The inferior branch is much shorter than the other, and it is attached 
directly below the posterior articular facet of the odontoid process, which 
is smooth and not cartilaginous, to the upper part of the posterior edge 
of its base, which is considerably rough. 

The use of this ligament is not merely to strengthen the connections 
between the three bones to which it is attached, but also to allow the 
atlas to rotate around the odontoid process as around an axis, in which 
the synovia] capsule assists, and at the same time to protect the spinal 
marrow from the action of this process. 

B. LIGAMENTOUS ENVELOP OF THE HEAD AND CERVICAL VERTEBRA. 

§ 856. Behind the crucial ligament, between it and the posterior 
ligament of the vertebral column to which it is loosely attached, we 



22 DESCRIPTIVE ANATOMY. 

find a broad layer of longitudinal fibres, which arises from the upper 
face of the basilar process of the occipital bone and descends to the third 
or fourth cervical vertebra. This layer unites above with the dura 
mater and below with the posterior bridge of the vertebrae. It is called 
the ligamentous envelop of the cervical vertebra (apparatus vertebrarum 
colli ligamentosus). 

II. COMMON EXTERNAL LIGAMENT BETWEEN THE HEAD AND THE CERVICAL 

VERTEBRA. 

§ 857. The common external ligament between the head and the 
cervical vertebrae is the cervical ligament (Lig. nuchoz s. cervicis), which 
begins at the spinous process of the seventh cervical vertebra, whence 
it extends to the posterior occipital spine and to its upper curved line. 
This ligament is thin and perpendicular, and gradually enlarges as it 
approaches the head. Its upper edge is thicker, it being formed of the 
united tendons of the muscles of the neck. It is continuous between 
the cervical vertebra) with the interspinal ligaments, and its posterior 
edge represents the supraspinal ligaments. 

IV. LIGAMENTS BETWEEN THE FIRST AND SECOND CERVICAL 
VERTEBRJE. 

§ 858. Beside the posterior ligament and the two common capsular 
ligaments, which are looser here than in the rest of the vertebral column, 
the anterior face of the odontoid process unites also with the centre 
of the posterior face of the anterior arch of the atlas by a loose capsular 
ligament. 

CHAPTER II. 

OF THE LIGAMENTS OP THE LOWER MAXILLARY BONE. 

§ 859. The ligaments of the lower maxillary bone are, 1st, those 
which unite it with the temporal bones ; and, 2d, those between it and 
the hyoid bones. 

I. LIGAMENTS OF THE TEMPORO-MAXILLARY ARTICULATION. 

§ 860. The temporo -maxillary articulation is formed by an interar- 
iicular cartilage, two synovial capsules, and by accessory fibrous liga- 
ments. 

I. INTERARTICULAR CARTILAGE AND SYNOVIAL CAPSULES. 

A. INTERARTICULAR CARTILAGE. 

§ 861. The interarticular cartilage (operculum cartilagineum) be- 
longs to the class of fibro-cartilages ; it is oval, situated horizontally, 



SYNDESMOLOGY. 23 

with concave surfaces, and much thinner in its centre than at the 
edges. There is often in its centre a cavity filled by synovial mem- 
branes, which are then directly united. Its circumference is attached 
only to these membranes, and its external edge slightly adheres to the 
fibrous ligaments. 

This fibro-cartilage diminishes the friction between the articular sur- 
faces of the two bones. 

E. SYNOVIAL CAPSULES. 

§ 862. One of the two synovial capsules (ligamenta cartilaginis 
intermedia) is situated above and the other below the interarticular 
cartilage. 

The superior synovial capsule arises from the anterior edge of the 
transverse articular tubercle and from the posterior edge of the articular 
cavity of the temporal bone, and is attached to the circumference of the 
interarticular cartilage. It unites above with the cartilaginous covering 
of the articular surface of the temporal bone, and below with the upper 
face of the interarticular cartilage. 

The inferior arises from the circumference of the maxillary condyle, 
and is attached to the edge of the interarticular cartilage, and unites 
partly with this cartilage and partly with the cartilage of the maxil- 
lary condyle. . 

These two capsules are very loose, and permit very extensive mo- 
tions, especially upward and downward, since they are not confined 
forward or backward by fibrous ligaments. 

II. FIBROUS LIGAMENTS. 

§ 863. The firmness of the temporo-maxillary articulation depends 
on an external and an internal fibrous ligament. 

A. EXTERNAL FIBROUS LIGAMENT. 

§ 864. The external fibrous -ligament (membrana maxillm inferioris) 
consists of very firm longitudinal fibres, which arise from the posterior 
extremity of the zygomatic process of the temporal bone, descend to 
the neck of the lower maxillary bone, and are attached to the out- 
side and partly to the posterior part of the circumference of the synovial 
capsule. It is very tense when the jaw is moved forcibly forward or 
backward, so that it limits these two motions. 

B. INTERNAL LATERAL LIGAMENT. 

§ 865. The internal lateral ligament (Lig. maxillae laterale) should 
not be considered, properly speaking, as belonging to the temporo-max- 



24 DESCRIPTIVE ANATOMY. 

illary articulation ; for it. is situated at some distance from it and adds 
nothing to its firmness. 

It is a thin, oblong, tendinous layer, arises from the spine of the sphe- 
noid bone, and descends obliquely from above downward, from behind 
forward, and from within outward, to the lower maxillary bone, where 
it is attached below the internal orifice of the dental canal. 

The vessels and the nerves of the lower maxillary bone pass between 
this ligament and its neck. Its principal use is, to enlarge those sur- 
faces to which the two pterygoid muscles are attached, the outer part 
of which arises from them, and it is situated between their outer extre- 
mities. 

II. LIGAMENTS BETWEEN THE SKULL, THE LOWER MAXILLARY BONE, 
AND THE HYOID BONE. 

§ 866. In nearly the same direction as the ligament already de- 
scribed, but more deeply situated, we find a membrane which is thinner, 
slightly tense, and formed by condensed cellular tissue : this is strength- 
ened only by some fibrous bands, which extend from the lower extre- 
mity of the styloid process of the temporal bone to the posterior edge 
of the angle of the jaw, and send a cylindrical slip to the small horn of 
the hyoid bone. This is the stylo-mylo-hyoid ligament (Lig- stylo-mylo 
hyoideum) : it serves partly to unite the temporal, the inferior maxillary 
and the hyoid bones, and partly to enlarge the surface to which the 
pterygoideus intemus muscle is attached. 

CHAPTER III. 

OF THE LIGAMENTS OP THE HYOID BONES. 

§ 867. The body or the central portion of the hyoid bone articulates 
with the large and small horns by two synovial capsules ; one of them 
is narrow and tight, and the second is broad and loose. Both, but the 
first particularly, are strengthened by tendinous fibres. 

The posterior extremity of the large Horn is attached to the superior 
horn of the thyroid cartilage by a round perpendicular ligament, in the 
centre of which we often find a round cartilage or bone. 



SYNDESMOLOGY, 25 

SECTION III. 

OF THE LIGAMENTS OF THE EXTREMITIES. 

CHAPTER I. 

OF THE LIGAMENTS OF THE UPPER EXTREMITIES. 

§ 868. The ligaments of the upper extremities are, 

1st. Those between the trunk and the upper extremities. 

2d. Those of the scapula. 

3d. Those of the elbow-joint. 

4th. Those of the fore-arm. 

5th. Those of the wrist-joint. 

6th. Those of the fingers. 

ARTICLE FIRST. 

LIGAMENTS BETWEEN THE TRUNK AND THE UPPER 
EXTREMITIES. 

§ 869. The upper extremities are attached to the anterior and 
superior part of tbe trunk by the clavicles, to which they are united by 
synovial and fibrous ligaments. The scapula, trunk, and head, are 
united only by muscles. 

The clavicle is articulated, by its anterior extremity, with the clavicle 
of the opposite side, and also with the first piece of the sternum and the 
first rib. 

I. INTERCLAVICULAR LIGAMENT. 

§ 870. The interclavicular ligament (Lig. inter clavicular e, trans- 
versum) is thin ajid formed of transverse fibres. Its upper edge is loose 
and concave ; the inferior is straight or slightly convex, and is mostly 
attached to the upper part of the handle of the sternum. It extends 
from the upper extremity of the articular surface of the internal edge 
of one clavicle to the corresponding part of the opposite clavicle; so 
that it unites these bones with each other and with the sternum, and 
prevents them from moving too far backward. 

II. STERNO-CLAVICULAR ARTICULATION. 

§ 871. The clavicle and sternum are connected by an interarticular 
cartilage, two synovial capsules, and a, fibrous ligament. 
Vol. II. 4 



26 



DESCRIPTIVE ANATOMY. 



A. INTERARTICULAR CARTILAGE. 



§ 872. The interarticular cartilage is* generally very soft, almost 
membranous, extremely thin in its centre, and, on the contrary, very 
thick in its circumference, so that its two faces are concave. It is 
attached downward, backward, and' inward, by a thick and firm fibro- 
cartilaginous tissue to the facet where the clavicle unites with the ster- 
num ; downward and forward to the clavicle, and to the inner part of 
the cartilage of the first rib ; upward, forward, and outward, to the mar- 
gin of the articular facet of the clavicle. It unites intimately forward 
and backward, with the fibrous ligaments of the sterno-clavicular 
articulation. It is firmly attached, and admits of but little motion on 
account of the thickness and breadth of that part of the cartilage which 
is external to the synovial capsules. 



B. SYNOVIAL CAPSULES. 



§ 873. The synovial capsules are two, an upper and external, and a 
loioer and internal. 

The upper arises from the margin of the anterior part of the anterior 
articular facet of the clavicle, which is smooth and covered with carti- 
lage, and is attached around the upper face of the thin and internal 
part of the interarticular cartilage. 

The lower arises from the upper part of the lower face of this 
cartilage, and is attached to the anterior, inferior, and external portion 
of the articular facet of the handle of the sternum. 

Both are small and narrow. 

C. FIBROUS LIGAMENTS. 

§ 874. The synovial capsules are strengthened by fibrous ligaments 
which are attached pnnci] illy to the anterior and posterior parts of 
their circumference, but never form a dense layer. 

The anterior fibrous ligament is the stronger, ana! is formed by per- 
pendicular descending fibres. The posterior is formed tf radiated fibres 
which are attached partly to the posterior face of the upper part 
of the handle of the sternum and partly to the cartilage of the first rib 
and are united with the anterior and the posterior periosteum of the 
sternum. 

III. OF THE COSTO-CLAVICULAR LIGAMENT, OR THE RHOMBOID LIGA- 



MENT 



§ 875. The space between the sternal extremity of the claviYle the 
anterior extremity of the rib and most of its cartilage, is fil « 1 bv a 
ligament formed of oblique intercrossing fibres : this arises "from the 
posterior edge of the clavicle, goes obliquely from above downward 
and from behind forward, and is inserted in the upper and posterior 



SYNDESMOLOGT. 27 

edge of the rib and of its cartilage. A band of transverse fibres is often 
detached from its inner and inferior extremity, which goes to the lower 
external extremity of the articular facet of the handle to which the 
clavicle is attached. It is called the rhomboid ligament (Lig. rhom- 
boideum), from its form. It unites the bones to which it is attached, 
retains the clavicle and the first rib in their places, and increases the 
number of points of attachment of the subclavian muscle. 



ARTICLE SECOND. 

OF THE LIGAMENTS OF THE SCAPULA. 

§ 876. Some of the ligaments of the scapula unite this bone with 
the clavicle, and others directly or indirectly with the humerus. 

I. OF THE LIGAMENTS BETWEEN THE SCAPULA AND THE CLAVICLE. 

§ 877. The clavicle and scapula are united by a capsular ligament 
and by several fibrous ligaments. 

A. ACROMIO-CLAVICULAR LIGAMENT. 

<} 878. A capsular ligament (connexio claviculoz cum acromio) unites 
the acromion process of the scapula with the humeral edge of the 
clavicle. We may then term it the acromioclavicular ligament (Lig. 
acromioclavicular e). It is short, very tense, and sometimes double, 
when an inter-articular cartilage exists between these two bones : this 
articular cartilage, however, is not constant, and often fuses with them 
completely. 

Very solid and transverse fibres go upward and downward, but espe- 
cially upward, over this ligament, which are attached also to the 
circumference of the interarticular cartilage. 

B. CORACO-CLAVICULAR LIGAMENT. 

§ 879. The fibrous ligaments are generally two, which are also 
known as the common ligaments of the scapula, and both unite 
the clavicle with the coracoid process of the scapula. We cannot 
however deny but that it would be more convenient to consider them 
simply as two bands of the same ligament, the fibres of which have 
not the same direction ; one of them is external, the other internal, 
and they are uninterruptedly continuous with each other. This 
ligament is called the coraco-clavicular ligament {Lig. coraco-clavi- 
culare),' to distinguish it from the preceding, and is formed by strong 
thjck fibres. 

It arises from the outer half of the upper face of the coracoid process, 
and is composed of ascending fibres. It is attached by its upper ex- 



28 



DESCRIPTIVE ANATOMY. 



tremity to the inferior face, and to the posterior edge of the scapular 
extremity of the clavicle, but it does not extend to the outer end of this 
bone. 

The internal and posterior fibres are shorter and more perpendicular : 
the anterior and external aie longer and more oblique. 

The two bands which form this ligament are commonly described, 
the inner as the common conoid ligament, and the external as the 
common trapezoid ligament of the scapula (Lig. scapulae communia 
conoides et trapezoides). 

The conoid ligament arises from the root of the coracoid process, 
proceeds more from before backward, and is attached to the posterior 
edge of the clavicle : its blunt summit corresponds to the coracoid 
process, and its broader base to the clavicle. Its anterior fibres are 
shorter and more perpendicular than the posterior. 

The trapezoid ligament arises from about the centre of the upper 
part of the coracoid process ; its direction is more transverse, and it is 
attached more externally than the preceding, to the inferior face of the 
scapular extremity of the clavicle. The anterior are longer than the 
posterior fibres. 

II. OF THE LIGAMENTS BETWEEN DIFFERENT PARTS OF THE SCAPULA, 
OR OF ITS PROPER LIGAMENTS. 

§ 880. The proper ligaments of the scapula are simply fibrous, and 
extend, like a bridge, between the two eminences of this bone. 

A. ACROMIO-CORACOID LIGAMENT. 

§ 881. The acromio-coracoid ligament (Lig. coraco-acromiale s. 
anterius, majus, triquetrum) is a thin band formed of horizontal fibres 
which converge from before backward. It sometimes arises by two 
separate bundles from the whole posterior edge of the coracoid process 
and is attached to the anterior extremity of the acromion process. 
It gradually contracts from before backward, and from within 
outward, and terminates in a very acute summit. The inner and 
outer edges (the former of which is the longer) are loose. The 
whole ligament is covered by the scapular extremity of the 
clavicle, and by the deltoid muscle, rests on the anterior part of the 
supraspinatus muscle which keeps it in place, and terminates by a thick 
layer placed under the deltoid muscle ; it projects over the scapulo- 
humeral articulation, and thus prevents the displacement of the 
humerus upward. 

B. COSTO-CORACOID LIGAMENT. 

§ 882. The costo-coracoid ligament (Lig. coraco-costoideum) calle 
also the coracoid (Lig. coracoideum) or the proper small ligament «f 

(1) Soemmering, loc. cit., p. 42.-Bichat, An. deser., vol. i. p. 273. 



STNDESMOLOGY. 29 

the scapula (Lig. scapulae, proprium, posterius, minus, obliquum), is 
much smaller than the preceding ; it has the form of a thin square 
band, and it extends from the root of the coracoid process to the inner 
end of the upper edge of the scapula or of the rib above the scapular 
fissure, which it changes into a canal through which the nerves and 
vessels of the shoulder pass. It often ossifies. 

III. HUMERO-SCAPULAR ARTICULATION. 

§ 884. The humero-scapular articulation is formed by a synovial 
capsule and a fibrous capsule, which covers the former. These two 
capulses are called the large capsular ligament of the humerus (Lig. 
capsulare ossis humeri magnum). 

A. SYNOVIAL CAPSULES. 

§ 884. The synovial capsule covers the articular surface of the 
scapula above, and the head of the humerus below. After leaving 
these two surfaces, it reflects on itself to form a large and loose sac. 

This sac, like all the synovial capsules, is entirely closed; but it covers 
also the bicipital groove, and even the upper part of the tendon of the 
long portion of the biceps muscle, for it is reflected from the groove 
over the tendon, although no opening exists on this part. 

B. FIBROUS CAPSULE. 

§ 885. All the surface of this synovial capsule is covered by a com- 
plete fibrous capsule, which forms a broad and loose sac, open on the 
two sides. It is attached above to the circumference of the glenoid 
cavity of the scapula, and below to the neck of the humerus : in both 
points it is continuous with the periosteum. 

Its upper edge is continuous with a fibro-cartilaginous ring, which 
surrounds the glenoid cavity, and' slightly projects above its surface. 
It is called the glenoid ligament (Lig. glenoideum). It is formed of 
closely interlaced fibres, and is thicker at its upper portion than in its 
other parts, since it is there strengthened by a fibrous band coming 
from the coracoid process. Its internal face is thinner, and even there 
We occasionally see spaces filled by the tendon of the subscapularis 
muscle. 

It is strengthened above by the tendon of the supra-spinatus muscle, 
backward by that of the infra-spinatus muscje and of the teres minor 
muscle. 

Below and forward its internal edge presents a slight opening, through 
which the long tendon of the biceps flexor muscle passes. 

The looseness of this ligament allows great freedom of motion in the 
upper extremities. 



30 DESCRIPTIVE ANATOMY. 

ARTICLE THIRD. 

OF THE LIGAMENTS OF THE ELBOW-JOINT. 

§ 886. TVe find at the articulation of the elbow a synovial capsule 
and several fibrous ligaments. 

I. SYNOVIAL CAPSULE. 

§ 887. The synovial capsule (membrana cubiti capsularis) unites the 
lower extremity of the humerus and the upper extremities of the ulna 
and radius. 

Above, after covering the cartilaginous articular surface of the 
lower extremity of the humerus with which it is blended, it detaches 
itself forward from the upper part of the two anterior articular cavities ; 
on the sides from the base of the two condyles along the posterior car- 
tilaginous edges of the pulley and of the lower head ; backward from 
the upper part of the posterior articular cavity. From these different 
points it goes toward the radius and ulna, to which its inferior edge is 
attached. It is much looser and more extensive than on the sides. 

The portion attached to the radius descends deeply below the head 
of this bone to the commencement of its neck ; so that the head, enve- 
loped by the reflected portion of the synovial capsule, is loose and in- 
closed in its cavity. 

From the inferior part of the neck of the radius it goes on the anterior 
side of the upper extremity of the ulna ; there it lines the lateral sig- 
moid cavities, and the upper edge of the condyle and the coronoid pro- 
cess of the ulna. 

We find considerable masses of articular fat in many places, but 
principally in the anterior and posterior articular cavities, especially 
above the pulley, between the heads of the radius and ulna, and within 
the large upper sigmoid cavity ^consequently, in all those parts most 
exposed to compression and friction. 

From this description it follows that this synovial capsule, between 
the anterior part of the articular face of the humerus and that of the 
radius, is much looser than between the posterior and that of the ulna, 
which is owing to the greater extent of morion of the radius ; for the 
radius rotates on its axis, while the ulna has only the motions of flexion 
and extension. 

II. FIBROUS LIGAMENTS. 

§ 888. The synovial capsule of the elbow-joint is strengthened, on 
its anterior and posterior faces and on the sides, by fibrous bands, which 



SYNDESMOLOGY. 31 

may be considered so many distinct ligaments, the lateral, the anterior, 
and the posterior. 

The two lateral ligaments are oblong and formed of longitudinal fibres. 

I. INTERNAL LATERAL LIGAMENT. 

§ 889. The internal lateral ligament (Lig. cubiti laterale internium) 
arises from the inner part of the anterior face of the internal condyle of 
the humerus, covers the internal part of the synovial capsule, and is 
attached below to the internal edge of the coronoid process of the ulna. 

II. EXTERNAL LATERAL LIGAMENT. 

§ 890. The external lateral ligament (Lig. cubiti laterale externum) 
extends from the anterior face of the external condyle to the inner por- 
tion of the circumference of the head of the radius. 

III. ANTERIOR AND POSTERIOR LIGAMENTS. 

§ 891. The anterior and posterior fibrous ligaments (Lig. cubiti 
anlerius et posterius) are formed of less regular fibres, and they are 
broader but weaker than the lateral ligaments. 

The anterior is strongest in its centre. It is formed of longitudinal 
fibres, which are loose at its upper part, oblique in the centre, and more 
transverse in the lower part. 

The posterior is not well marked, except on the sides, where it is 
strongest and composed of bands which converge downward ; in other 
parts it is hardly seen. 



ARTICLE FOURTH. 

OF THE LIGAMENTS OF THE BONES OF THE FORE-ARM. 

§ 892. The bones of the fore-arm are united in most of their length, 
but not in the same manner, nor do the agents of union form a conti- 
nuous whole. We find at the upper part two fibrous ligaments, in the 
centre a fibrous ligament, and below a synovial capsule. 

I. SUPERIOR REGION. 
I. ANNULAR LIGAMENT. 

§ 893. The annular ligament of the radius (Lig. radii annulare) is 
very strong, and arises from the anterior and posterior extremities of the 
lateral sigmoid articular cavity of the ulna. It is formed of horizontal 
and circular fibres, and loosely surrounds the neck of the radius. Be- 



** DESCRIPTIVE ANATOMY. 

hind the sigmoid cavity it forms a circle, lined by the synovial membrane 
of the elbow-joint, in which the head and the neck of the radius move. 
Its fibres interlace above with those of the anterior, posterior, and ex- 
ternal lateral ligaments ; but it terminates downward in a loose edge. 

This ligament strengthens the synovial capsule ; it confines the 
motions of the upper part of the radius and keeps it in place. 

II. ROUND LIGAMENT. 

§ 894. The round or oblique ligament, called also, but very im- 
properly, the transverse ligament (Lig. antibrachii, s. cubili teres, s. 
membrana obliqua, s. transversa), is a thin but strong band, broadest at 
its upper part, situated on the anterior face of the bones of the fore-arm : 
it descends obliquely from the tubercle of the ulna to the internal face 
of the radius, and is attached below its tubercle. 

Its uses are to limit the motion of supination in the radius. 

Hi MIDDLE REGION. 
INTEROSSEOUS LIGAMENT. 

§ 895. The interosseous ligament {Lig., s. membrana antibrachii 
interossea) unites the two bones of the fore-arm in most of their length. 
It occupies the deepest region of the fore-arm, being situated between 
the extensor and the flexor muscles. Its upper part commences below 
the tubercle of the radius. It is attached in its whole extent to the 
external edge of the ulna, and to the internal edge of the radius, and 
extends almost to the lower extremity of the bones of the fore-arm ; so 
that its lower part is much broader than its upper. 

It is formed of parallel fibres ; these descend from the radius to the 
ulna, and are much stronger at its upper than at its lower part. In 
several places, particularly above and below, we observe foramina for 
the passage of the interosseous vessels. 

III. INFERIOR REGION. 
SYNOVIAL CAPSULE. 

§ 896. The inferior extremities of the bones of the fore-arm are united 
by a very loose and very broad synovial capsule (membrana capsularis 
sacciformis extremitatum inferiorum cubiti), which is strengthened only 
by some straight and isolated fibres. This capsule arises on the ulna 
from the semilunar cavity and on the radius from the corresponding 
eminence. & 



SYNDESMOLOGY. 33 



ARTICLE FIFTH. 

OF THE LIGAMENTS BETWEEN THE FORE-ARM AND THE 

WRIST. 

§ 897. The articulation of the bones of the fore-arm with those of 
the wrist(l) presents a thin and loose synovial capsule and some very 
strong fibrous bands, Which cover its external surface. 

1. SYNOVIAL CAPSULE. 

§ 898. The synovial capsule arises above from the edge of the tri* 
angular and cartilaginous articular surface at the lower extremity of 
the radius, and from a fibro-cartilage which terminates this articular 
surface forward ; below, from the cartilaginous circumference of the 
superior or antibrachial articular facet of the scaphoid, the semilunar, 
and the pyramidal bones, consequently from the bones of the upper 
range of the carpus, except the pisiform bone, and also fills the spaces 
between these bones. Prolongations, called mucous ligaments (ligw- 
menta mucosa), go from several of its parts, among which we distin- 
guish that which proceeds from the union of the first two bones of 
the carpus to the projection which arises between the two portions 
of the articular surface of the radius. These prolongations increase 
the extent of the surface which secretes synovia. 

II. INTERARTICULAR CARTILAGE, 

§ 899. The interarticular cartilage (cartilago triangularis interme- 
dia extremitatum ossium antibrachii) (§ 898) is a small triangular 
fibro-cartilage ; its base looks inward, and its summit outward ; it is 
loose at its external edge, and its internal edge is attached to the ante- 
rii dge of the lower articular surface of the radius ; and it is situated 
■1 the lower edge of the ulna and the semilunar bone. Its 
upper face is covered by the synovial capsule, and the inferior by the 
synovial membrane of the articulation of the fore-arm with the carpus, 
so that it belongs to neither ; but as it evidently concurs to form the 
articular surfaces of the bones of the fore-arm, which correspond to the 
carpus, we must study it here, instead of describing it when treating 
of the articulation of the bones of the fore-arm, as is generally done. 

(1) The carpal ligaments in the bark and the palm of the hand, and also the pro- 
per carpal ligament in the palm of the hand, are not mentioned here, as they serve 
not to unite the bones, but only to retain the tendons in their places. They will be 
described in myology. 



Vol. II. 



34 DESCRIPTIVE ANATOMY. 



III. FIBROUS LIGAMENTS. 

§ 900. We may describe, as is most usual, four principal fibrous 
ligaments, which strengthen the synovial capsule of this joint ; the 
palmar, the dorsal, the radial, and the idnar. The first two are larger 
and particularly broader than the others. 

I. FIBROUS PALMAR LIGAMENT. 

§ 901. The fibrous palmar or the anterior ligament (Lig. accessorium 
articuli cubito-carpalis, s. lacerti adscitilii palmaris, with the Lig. ac- 
cessorium obliquum et rectum) is composed of mostly horizontal bands, 
which leave the lower extremity of the palmar face of the radius and 
the styloid process of the ulna, go a little outward, meet, and unite, 
being attached to the palmar face of the pyramidal and the semilunar 
bones. These bands form particularly the oblique accessory ligament 
(Lig. accessorium obliquum, Weitbrecht.) 

Besides, from the posterior part of the palmar face of the inferior 
edge of the radius arise strong perpendicular fibres, which are attached 
above the preceding to the upper edge of the palmar face of the pyra- 
midal and semilunar bones, thus forming the straight accessory liga- 
ment {Lig. accessorium rectum). 

These fibres are generally interrupted in parts. 

II. riBROUS DORSAL LIGAMENT. 

§ 902. The fibrous dorsal ligament (Lig. fibrosum dorsale articuli 
cubito-palmaris), or the rhomboid ligament (Lig. rhomboideum), is 
formed of several very strong bands which are also interrupted from 
place to place ; these arise from the external edge of the articular face 
of the radius, go obliquely from before backward, and are attached to 
the dorsal face of the pyramidal bone. Their posterior part is the 
thickest, and there the fibres are most compactly arranged. 

III. FIBROUS ANTERIOR OR RADIAL LIGAMENT. 

§ 903. The fibrous anterior or radial ligament (Lig. radiate articuli 
cubito-carpalis) arises from the summit of the styloid process of the 
radius, unites at its upper part with the anterior bands of the dorsal 
ligament, and terminating rather pointedly, is attached to the anterior 
asperity of the radial face of the scaphoid bone. 

IV. FIBROUS POSTERIOR OR ULNAR LIGAMENT. 

§ 904. The fibrous posterior or idnar ligament (Lig. cubitale arti- 
culi cubito-carpalis) is longer and stronger than the preceding, and 
arises from the summit of the styloid process of the ulna, and, united 



SYNDESMOLOGY. 35 

with the posterior part of the dorsal ligament, is attached to the dorsal 
face and to the ulnar side of the pyramidal bone. 



ARTICLE SIXTH. 

OF THE LIGAMENTS OF THE CARPAL BONES. 

§ 905. The ligaments of the carpal bones comprise those which 
unite the two ranges and those which unite the separate bones of the 
same. 

I. OF THE LIGAMENTS BETWEEN THE TWO RANGES. 

§ 906. The two ranges of carpal bones are connected together by 
a synovial capsule and by fibrous ligaments. 

I. SYNOVIAL CAPSULE. 

§ 907. The short and close synovial capsule extends from the first 
three bones of the upper range to the four bones of the lower, unites 
with their cartilaginous faces and also sends small culs-de-sac between 
the adjacent bones, which are covered by the fibrous ligaments; by 
which the surfaces are kept in continual contact. 

II. FIBROUS LIGAMENTS. 

§ 908. The fibrous ligaments which exist only externally are very 
similar to those of the radio-carpal articulation, as respects situation, 
number, and proportional size. 

The -palmar ligament is short, but broad and triangular. Its central 
fibres are transverse, its anterior and posterior fibres are oblique ; all 
converge towards the base. They arise from the pyramidal and sca- 
phoid bones, and are attached below to the trapezoides and the os 
magnum. 

The dorsal ligament is weaker than the preceding. It is formed of 
transverse fibres, and partly of those which are a little oblique. It is 
attached above to the dorsal face of the three anterior bones of the 
upper range, and below, to the upper region of the dorsal face of the 
four bones of the lower range. 

The anterior lateral ligament is formed of perpendicular fibres which 
extend from the radial side of the scaphoid bone to the os trapezium. 

The posterior lateral ligament is situated between the base of the 
unciform process of the unciform bone and the outer edge of the pyra- 
midal bone. 



36 DESCRIPTIVE ANATOMY. 



III. LIGAMENTS BETWEEN THE PISIFORM DONE AND THE ANTERIOR RANGE. 

§ 909. Besides these ligaments we find two others which are 
oblique ; the upper is smaller, the lower is stronger ; these go from 
the anterior extremity of the pisiform bone to the unciform bone : the 
second is attached to the inferior face of the body of this last bone, and 
the other to the summit of its unciform process. 

II. OF THE ARTICULATION OF THE DIFFERENT CARPAL BONES. 

I. SUPERIOR OR ANTIBRACHIAL RANGE. 

A. ARTICULATION OF THE CORRESPONDING FACES. 

§ 910. The four bones of the upper range of the carpus are arti- 
culated with each other differently, and do not possess the same 
degree of motion. 

The corresponding faces of the three anterior bones are united supe- 
riorly by short, firm, and solid fibres, which cover the culs-de-sac of the 
synovial membrane (§ 907) ; these are called transverse or interosseous 
ligaments (Lig. transversa, s. inlerossea). The fourth on the contrary 
is attached to the pyramidal bone by a very loose capsule, the dorsal 
face of which is covered by transverse fibres. 

B. ACCESSORY LIGAMENTS. 

§ 911. Beside the interosseous ligament (§ 910) we also see, in 
several parts of the corresponding faces of the carpal bones, fibres, 
which go from one of these bones to another; these are called the 
dorsal and the palmar ligaments of this range. These ligaments are 
formed of transverse fibres. They unite with each other and also 
with the supplementary fibres of the synovial capsule, and are stronger 
in the palm of the hand than on the back. 

II. INFERIOR OR METACARPAL RANGE. 

§ 912. The corresponding faces of the os magnum and of the unci- 
form bone, of the os magnum and of the trapczoides, are united 
by transverse and very tense interosseous ligaments, which are seen 
at their anterior portion. The strongest are situated between the first 
two bones. 

We also observe in this range transverse dorsal and palmar liga- 
ments, which are formed for the most part of several distil n I I 
these extend from the different small bones of the anterior range to 
bones adjacent, and usually to those of the succeding range : we 
generally number three on each side; they are continuous with the 
fibrous ligaments of the articulation between the two ranees. 



SVNDESMOLOGY. 37 



ARTICLE SEVENTH. 

OF THE LIGAMENTS OF THE CARPO-METACARPAL ARTICU- 
LATION. 

§ 913. The five metacarpal bones are united by synovial mem- 
branes and external fibrous ligaments with the bones of the anterior or 
inferior carpal range, and also by bands of fibres with the pisiform 
bone. 

I. SYNOVIAL CAPSULE. 

§ 914. The synovial capsule of the first metacarpal bone is loose 
and broad ; it arises from the edge of the articular surface of the tra- 
pezium. The others are for the most part only prolongations of the 
common synovial capsule (§ 907). 

II. FIBROUS LIGAMENTS. 

§ 915. The synovial capsule of the first metacarpal bone is strength- 
ened on the radial side by the tendons of the abductor muscles, and 
also on its edge by longitudinal fibres, which extend from the os trape- 
zium to the first metacarpal bone. These fibres it is true do not exist 
every where, but they are strongest on the dorsal face ; and as they 
are almost entirely deficient in some places, we usually number four 
ligaments in this articulation, the dorsal, the palmar, and two lateral 
ligaments, the external, and the internal. 

§ 916. The fibrous ligaments of the four other metacarpal bones 
are divided into dorsal and palmar. 

The dorsal ligaments are composed of oblique and perpendicular thin 
fibres, which are generally united in bands ; these go from the dorsal 
faces of the anterior range of the carpal bones to the upper extremity 
of the dorsal faces of the metacarpal bones. 

The palmar ligaments on the contrary are composed of more hori- 
zontal, and in part of more oblique fibres, which are mostly interlaced 
with the inferior palmar ligaments of the metacarpal bones. They 
extend from the palmar face of the anterior carpal range to the palmar 
face of the posterior extremity of the metacarpal bones. 

The strongest of all these ligaments goes from the anterior extremity 
of the posterior face of the trapezium to the base of the third meta- 
carpal bone, and is attached to its anterior edge. 

We find also some superficial bands which extend from the summit 
of the unciform process of the unciform bone, from within outward, to 
the base of the fifth metacarpal bone. 

§ 917. A very strong round ligament arises from the inferior extre- 
mity of the pisiform bone, and goes directly to the base of the fifth 



38 DESCRIPTIVE ANATOMY. 

metacarpal bone, and which, passing under the band extended from 
the unciform bone to the fifth metacarpal bone, goes obliquely to the 
base of the third and the fourth, where it unites with the large ligament 
described above (§ 909). 

ARTICLE EIGHTH. 

OF THE ARTICULATION OF THE METACAPAL BONES WITH 
EACH OTHER. 

I. SYNOVIAL CAPSULE. 

§ 918. The metacarpal bones of the second, third, fourth, and fifth 
fingers touch each other at their posterior extremities by smooth and 
cartilaginous surfaces, over which passes a synovial membrane, which 
is sometimes only a simple prolongation of the synovial capsule, situ- 
ated between the posterior and the anterior ranges of the carpal bones 
(§ 910), but which sometimes also forms several distinct sacs. 

The metacarpal bone of the thumb is entirely insulated from the 
others. 

II. FIBROUS LIGAMENTS. 

§ 919. The fibrous ligaments are situated between the posterior 
and the anterior extremities of the metacarpal bones. The posterior 
are of three kinds, the dorsal, the palmar, and the lateral ; the anterior 
are single. 

I. POSTERIOR FIBROUS LIGAMENTS. 

§ 920. The dorsal ligaments are four ; one between every two 
metacarpal bones.(l) All are composed of transverse fibres. They 
increase very much- in breadth and power from the thumb to the fifth 
finger ; the first is however larger than the second. Sometimes they 
are divided into two bands, an anterior and a posterior ; the latter is 
broader. 

The lateral ligaments are the narrowest of all. They are usually 
formed of several distinct bands, and descend below the former from 
the upper edge of the ulnar side of the metacarpal bone, to the lower 
edge of the radial side of the next bone ; at the same time they turn a 
little forward. 

The inferior or palmar ligaments are the strongest. They arc 
formed of transverse fibres and extend in this direction between the 
inferior faces of the bases of the adjacent metacarpal bones. 

The lateral and palmar ligaments are sometimes deficient between 
the first and second metacarpal bones. 

(1) Generally, only three are admitted, the ligament between the thumb and finger 
being- considered deficient ; but nice dissections convince us that this opinion is erro- 
neous. 



SYNDESMOLOGY. 39 



II. ANTERIOR FIBROUS LIGAMENTS. 



§ 921. There are three anterior fibrous ligaments formed of trans- 
verse fibres ; they are very tense, and extend between the inferior faces. . 
of the heads of the second, third, fourth, and fifth metacarpal bones, 
where they are continuous with the tendinous fibres. They are much 
larger and more movable than the preceBing. 



ARTICLE NINTH. 

OF THE METACARPO-PHALANGEAN AND PHALANGEAN 
LIGAMENTS. 

§ 922. The anterior extremities of the metacarpal bones, and the 
posterior extremities of the bones in the first phalanx, and also the 
three phalanges, are united exactly in the same manner by synovial 
capsules and accessory ligaments. 

I. SYNOVIAL CAPSULES. 

§ 923. The synovial capsules are loose and broad, especially on the 
dorsal face of their circumference. At their upper portion, that which 
looks towards the fore-arm, they extend much farther on the inferior 
extremity of the upper of the two bones, between which they are found, 
so that beside the cartilaginous portion they embrace a considerable 
part which presents no cartilage. 

The synovial capsule of the metacarpo-phalangean articulation is 
much looser and broader than are those of the phalangean articula- 
tions. 

II. FIBROUS LIGAMENTS. 

§ 924. Each of these articulations is confined by three strong liga- 
ments, two lateral and an inferior ligament. 

I. LATERAL LIGAMENTS. 

§ 925. The two lateral ligaments, the external, and the internal, are 
rhomboidal, and formed of oblique fibres. They extend from the two 
rough depressions, at the two extremities of the head of the upper 
bone to the same depression in the base of the lower. Being attached 
directly to the lateral faces of the synovial capsule, they prevent it from 
separating on the sides. 

II. INFERIOR LIGAMENT. 

I 

§ 92G. The inferior, internal, or anterior ligament is situated on the 
palmar face of the synovial capsule, and is intimately connected with 



40 DESCRIPTIVE ANATOMY. 

it. It is composed of transverse fibres. Its tissue is fibrocartilaginous. 
It forms a very thick square layer, which is more broad than long, and 
bi-concave, the upper face of which looks towards the articulation, and 
J,he lower to the flexor tendon. 

The upper part of the synovial capsule has no special fibrous liga- 
ment, but it is strengthened by the tendon of the extensor muscle of 
the fingers. # • 

III. UNGUAL LIGAMENTS. 

§ 927. The ungual ligaments (Lig. unguium, s. lateralia subtensa) 
are fibrous oblong and rounded bands, situated on both sides of the 
bones in the third phalanx, and extend from the lateral tubercles of the 
base to those of the summit. These ligaments are united to the lateral 
edges of the roots of the nails, and serve to render them firm, and 
to enlarge the surface on which the nervous tissue of the fingers is 
expanded, 

CHAPTER II. 
OF THE LIGAMENTS OF THE INFERIOR EXTREMITIES. 

§ 928. The ligaments of the lower extremities are, 

1st. Those of the pelvis, and those which unite either the lower ex- 
tremities to the trunk, or the upper parts of the lower extremities with 
each other. 

2d. The ligaments of the ilio-femoral joint. 

3d. The ligaments of the knee-joint. 

4th. The ligaments of the leg. 

5th. The ligaments of the tibio-tarsal joint. 

6th. The ligaments of the tarsus. 

7th. The ligaments of the tarso-metatarsal joint. 

8th. The ligaments of the metatarso-phalangean and phalangean 
joints. 



ARTICLE FIRST. 

OF THE LIGAMENTS OF THE PELVIS. 

§ 929. The bones of the pelvis are connected by fibro-cartilages and 
by fibrous ligaments ; but there are no apparent synovial capsules. 
The fibro-cartilages are the principal and most extensive modes of 
union. The fibrous ligaments only strengthen the joint formed by the 
fibro-cartilages ; some pass upon these articulations, others go to other 
parts, so that they assist to form the walls of the pelvis, to increase 



SYNDESMOLOGr. 41 

the surfaces for the insertion of the muscles, and to protect the vessels 

and nerves. 

I. FIBRO-CARTILAGINOUS LIGAMENTS. 

§930. The articulations of the first kind are the sacro-iliac sym- 
physes, and the symphysis pubis. 

I. SACRO-ILIAC SYMPHYSIS. 

§ 931. The sacro-iliac symphysis {symphysis sacro-iliaca) unites the 
sacrum with the iliac bones. 

The mode of articulation is not the same in all parts. 

The smaller anterior and ear-shaped part of each of these two bones is 
covered with a smooth cartilage. These two cartilages touch ; but 
they are rarely united, at least completely. They are very distinct 
from each other and smooth in youth ; but as age advances they become 
rougher. We even find between them a fluid, which is thicker and 
less liquid than synovia. 

The two bones are very differently articulated at their larger poste- 
rior part. The bones there have no cartilage, are very rough, and 
separated very far from each other, especially upward and backward, 
and are united by a very dense, strong, felt-like, fibro-cartilaginous, 
irregular mass,* formed particularly of transverse fibres ; this mass 
is never torn, even when the bones are forcibly separated in this point, 
but detaches itself from one bone and remains fixed to the other. 

We may consider this posterior part of the sacro-iliac symphysis as 
a particular ligament. This has been done by Bichat, who terms it 
the sacro-iliac ligament (Lig. sacro-iliacum).{\) 

II. SYMPHYSIS PUBIS. 

§ 932. The symphysis pubis is situated between the upper parts of 
the descending branches of the pubes. 

The upper convex portion of the descending branch of the pubis is 
covered by a thin cartilage, which diminishes from above downward. 
This cartilage is entirely covered upward, downward, forward, and 
backward by a very thick layer of ligament, formed of transverse 
fibres, which are strongly developed at the lower part of the symphy- 
sis, and which are continuous with the periosteum and with the ten- 
dons of the adjacent muscles. This mass is generally thin on its inter- 
nal face, but often also projects longitudinally, a difference not de- 
pendent on the sex, although sex has no influence upon it. 

(1) W. Hunter, Remarks on the symphysis of the ossa pubis; in the London Med. 
Obs and Enq., vol. ii. p. 321-339.— Tenon, Mimoiresurlcsosdubassindelafemme, 
in the Mem. da I'Institut, vol. vi. Paris, 1806, p. 149-201. This memoir points out 
very clearly the varieties in the arrangement of the symphysis. 

Vol. II. 6 



42 DESCRIPTIVE ANATOMY. 

This fibrous layer always renders the articulation much firmer, and 
is even the principal agent of it. Its firmness however is lees than 
that of the fibro-cartilaginous layer in the sacro-iliac symphyses, since 
it is generally ruptured when the bones of the pubis are forcibly sepa- 
rated. 

The internal arrangement of the joint is not every where the same. 
Many anatomists admit that the two articular cartilages of the pubis 
are always united, others assert that they are always separated ; some 
think, that in the first case, they form a single cartilage. We have rea- 
son to think however that the last arrangement never exists, and that 
when a single cartilage only appears, there are, in fact, two, separated by 
a layer of fibro-cartilage, which intimately unites with them in their 
whole length, and is connected forward and backward with the fibrous 
layer already described ; at least we have, never found a single carti- 
lage, and this arrangement is always seen when the cartilages are 
united. The mass of fibro-cartilage is inversely as that of cartilage. 

The arrangement we have described is not general. At all periods 
of life, without distinction of age, sex, or any other circumstance, we 
find the two articular cartilages perfectly separated from each other 
by a greater or less space, and to a greater or less extent of their 
height, and united only at their lower extremity by a cartilage, or 
more properly by a fibro-cartilage, which may be removed without 
any suspicion of violence. If, sometimes, they are completely united, 
■they are also often entirely separated at their posterior part. The first 
mode of articulation is most common in the male, and the second in 
the female ; hence the sexes differ, if not constantly, at least primi- 
tively and really ; for it is not the consequence of pregnancy and par- 
turition, since it is found also in females before they have attained the 
age of puberty. 

II. FIBROUS LIGAMENTS. 

§ 933. Some of the fibrous ligaments of the pelvis are extended 
over the fibro-cartilages already described, and others attach the bones 
of the pelvis to its different parts. The former are supplementary, the 
latter proper ligaments. 

I. SUPPLEMENTARY FIBROTJS LIGAMENTS. 

§ 934. The supplementary fibrous ligaments of the sacro-iliac sym- 
physis are two, a posterior and an anterior. 

A. LONG POSTERIOR LIGAMENT OF THE PELVIS. 



935. The long posterior ligament of the pelvis (Lig. pelvis posticum, 
s. ossis ilei longum, s. superficial) extends almost perpendicularly, 
although a little from without inward, from the posterior extremity of 



SYNDESMOLOCY. 43 

the iliac crest to the summit of the transverse process of the fourth 
false sacral vertebra. It is very strong, and its form is oblong. 

B. SHOHT POSTERIOR LIGAMENT OF THE PELVIS. 

§ 936. The short posterior ligament of the pelvis {Lig. pelvis, a. 
ilei posticum breve, s. profundum) arises directly below the preceding ; 
it follows the same direction with it, but is shorter and narrower. It is 
attached to the summit of the transverse process of the third false 
sacral vertebra. 

§ 937. Besides these two ligaments, we also see arise from the pos- 
terior part of the internal face of the iliac crest some irregular fibres, 
which are for the most part oblique and flat, which intercross and pro- 
ceed from below upward, from without inward, and from behind for- 
ward. They unite in several bands, placed one after another from 
above downward, on the posterior face of the lateral parts of the upper 
false vertebrae of the sacrum. They concur with the preceding liga- 
ments to strengthen the sacro-iliac symphyses posteriorly.(l) 

The latter fibres lead to the anterior pelvic ligaments, which 
strengthen the sacro-iliac symphysis anteriorly. 

C. UPPER ANTERIOR PELVIC LIGAMENT. 

§ 938. The upper anterior pelvic ligament {Lig. pelvis anticum su- 
perius) is composed of obhque fibres, which ascend from the com- 
mencement of the posterior third of the iliac crest to the transverse 
processes of the last two lumbar vertebras. Its form is triangular ; it is 
very thin, and usually perforated for the passage of vessels and nerves, 
especially when it ascends to the transverse process of the fourth lum- 
bar vertebra. 

D. LOWER- ANTERIOR PELVIC LIGAMENT. 

§ 939. The lower anterior pelvic ligament {Lig. pelvis anticum infe- 
rias) arises from the same point as the preceding, but a little lower and 
a little farther back. It ascends obliquely from before backward, and 
is inserted in the transverse process of the fifth lumbar vertebra. It 
sends fibres downward and forward, which are inserted in the cartilage 
between the last lumbar and the first sacral vertebra. 

II. PROPER FIBROUS LIGAMENTS. 

§ 940. The proper fibrous ligaments are three on each side, and 
serve less to keep the bones in their position than to complete the pari- 
etes of the pelvis, by a substance which is solid, but is yielding to a cer- 
tain extent. Two of them are situated behind, one on each side of the 

(1) The lateral posterior ligament of the pelvis (Lig. lalerale posticum ossis ilei) 
will not be described in this place, but in myology. 



44 DESCRIPTIVE ANATOMY. 

pelvis ; the third is found forward. The posterior two unite two bones 
which are separated in the normal state ; the anterior is extended 
between the different parts of one and the same bone. 

A. SACBO-SCIATIC LIGAMENT. 

§ 941. The sacro sciatic ligament, the large posterior pelvic liga- 
ment, or the external posterior pelvic ligament {Lig. pelvis posticum 
magnum, s. tuberoso-sacrum) arises from the posterior and inferior iliac 
spine, from the posterior part of the external face of the inferior portion 
of the iliac bones, from the lateral edges, and from the outer part of the 
posterior face of the inferior portions of the sacrum and coccyx, goes 
obliquely forward, downward, and outward, contracts and thickens, 
and is attached to the internal edge of the inferior face of the sciatic 
tuberosity, where it again enlarges, and gives off a loose, falciform, 
and thin slip, which goes from the internal face of the ascending branch 
of the ischium to the descending branch of the same bone. 

Beside (§ 940) the uses pointed out, it enlarges the surfaces of at- 
tachment of the glutseus maximus muscle and closes the ischiatic 
notch, which changes into an oval foramen. 



B. SMALL SACBO-SCIATIC LIGAMENT. 



§942. The small sacrosciatic, or the 1 sacrospinal ligament (Lig. 
pelvis posticum parvum, s. sphloso-sacrum) arises before the preceding, 
from the outer edge of the inferior portion of the 6acrum and of the pieces 
of the coccyx. Its fibres go forward, outward, and upward ; the upper 
fibres descend, the central are straight, and the inferior ascend. It 
crosses the preceding, and is attached to the sciatic spine. Its form is 
an equilateral triangle, and its internal face is usually muscular. 

This ligament divides the great fissure or the sciatic foramen into 
two parts, an upper and a lower ; the first is much larger, and is sepa- 
rated from the other by the parts which pass through it. 



C. OBTUBATOR MEMDKANE. 



r § 943. The obturator membrane (Lig. s. membrana obturatoria, s. 
foraminis thyroidei ossium pubis) is thin, and formed of irregular fibres, 
which are mostly transverse and a little oblique, and which intercross 
variously. It arises from the sharp edges of the obturator foramen, 
further forward at its upper than at its lower portion, and it closes this 
opening almost entirely. We see at its upper and external part only 
a constant rounded and oblong hollow, through which the obturator 
vessels and nerves pass out from the cavity of the pelvis. But this hol- 
low is partly though imperfectly filled, for one or more bands of very 
strong transverse fibres go from the anterior edge of the ascending 
branch of the ischium to the beginning of the external edge of the de- 
scending branch of the pubis, several lines behind the membrane ; so 



SYNDESMOLOGY. 45 

that it would seem as if the upper fibres had been separated from each 
other in this place by the vessels and nerves which pass out from the 
pelvis. 

This space deserves notice ; since in thyroidal hernia, which is very 
rare, the abdominal viscera protrude from it and follow the course of 
the vessels. 

We also find other openings in the obturator membrane, particularly 
at its lower part ; but these are less constant. 

III. CHANGES OF THE PELVIC LIGAMENTS DURING PREGNANCY. (1) 

§ 944. Most usually, the bones of the pelvis have but a slight degree 
of motion on each other. Hence arises a question, whether this mobility 
is not increased under certain circumstances, and particularly if this 
change does not supervene during- pregnancy . 

Opinions differ in this respect. Some admit that the change occurs 
normally in every state of pregnancy. Others think it supervenes only 
under certain circumstances, as when the bones are diseased, or after 
very difficult labors ; and others, that it never takes place. 

The first of these opinions, already advanced by Pineau, is undoubt- 
edly the most correct ; since, according to the testimony of the best 
observers as Sandifort and Hunter, about the period of parturition, the 
symphyses, especially that of the pubis, always become looser, broader, 
and yield more easily. Beside, the latter symphysis is always broader 
in those females who are mothers of several children, than in virgins. 
This phenomenon deserves to be pointed out, as it demonstrates that 
all the parts interested in the act of parturition are analogously changed 
and become looser and more spungy. 

Finally, this change does not necessarily imply a real separation of 
the pubic cartilages, but only the softening of the fibro-cartilage, — a 
state in which the articular cartilages do not seem to participate. Tenon 
has maintained the contrary, but he is wrong : if the cartilages have 
sometimes been found really separated, this state must be considered as 
congenital or morbid ; since this arrangement has been observed even 
in very young girls, or the loose surfaces of the cartilages were like- 
wise rough, or pus has been found in the cavity.(2) 

This softening begins to take place in the eighth month of pregnancy, 
that is to say, precisely at that time when the lower region of the 
genital organs begins to enlarge and to secrete a great quantity of 
mucus. 

(1) S. Pineau, De distractione ossiumpubis inpartu naturali, deque rationibus qui- 
bus ea probatur ; in libris de virginitatis notis, graviditate et partu, book ii. — Sandi- 
fort, Depclvi ejusque inpartu ditatatione, Leyden,1763. — Hunter, loc. cit. — Louis, Sur 
Vecartcment des os du bassin, in the Mem de Vac. de chir., vol. iv. Paris. 1769. Hist, 
p. 63-102.— Tenon, loc. cit. 

(2) A singular case of the separation of the ossa pubis, in the Med. obs. and inq., 
vol. ii. no. 28. 



46 DESCRIPTIVE ANATOMY. 



This phenomenon is important, as by it the pelvis is enlarged and 
the act of parturition is facilitated. We must not confound it with the 
separation and the rupture of the cartilages, which may result from 
disease, either by destroying the fibro-cartilage between the two carti- 
lages or by detaching the latter from the surfaces of bone, where the 
fibro-cartilage separates from the two lateral cartilages ; so that then 
three cartilages are formed, two of which adhere, while the central one 
is loose.(l) 



ARTICLE SECOND. 

OF THE ILIO-FEMORAL ARTICULATION. 

§ 945. The ilio-femoral joint is formed by the fibro-cartilaginous pro- 
longation of the cotyloid cavity, a synovial capsule, a fibrous capsule, 
and an internal fibrous ligament. 

I, FIBRO-CARTILAGINOUS LIGAMENT. 

§ 946. The fibro-cartilaginous ligament of the cotyloid cavity, or 
the cartilaginous lip {Lig- cotyloideum jibro-cartilagineum, acelabuli 
labrum cartilagineum), is a complete triangular ring, formed of fibro- 
cartilage, which is several lines high and thick. It is thickest above 
and outward, and passes above the cotyloid fissure, so as to complete 
the edge of this cavity. Its loose edge is sharp and looks a little inward ; 
hence this ligament serves also to enlarge the cotyloid cavity, but con- 
tracts its circumference, although but slightly. 

This ligament is formed entirely of cartilaginous substance only 
where it passes over the cotyloid fissure. 

The space below is filled by some bands, situated, one within, the 
other without, — the external and internal ligaments of the cartilaginous 
lip (Lig. labri cartilaginei externum et internum), which are continuous, 
the first with the obturator membrane and both with the fibro-cartilage. 

II. SYNOVIAL CAPSULE. 

§ 947. The sijnovial capsule (capsularis sijnovialis membrana) passes 
from the bottom of the cotyloid cavity on the cartilaginous lip (§ 945). 
It is intimately connected with both, completely covers the external 
face of the lip, then is reflected on itself at an acute angle, and finally 
descends loosely to go to the femur. There it is attached to the lower 
extremity of the neck, goes to the anterior oblique line, descending 
lower forward than backward, reflects at an acute angle from below up- 
ward, and blends with the cartilage which covers the head. 

(1) Tenon, loc. cit., Onsiemc obs., p. 174. 



SYNDESMOLOGY. 47 

The posterior, superior, inferior, and external parts of the cotyloid 
cavity are covered by a semicircular cartilage, which extends, on all sides 
except the cotyloid notch, even to the loose edge of the cavity and to 
the cartilaginous lip, from which it is evidently separated. This carti- 
lage is intimately connected with the synovial capsule. 

The anterior and middle part of the cotyloid cavity is the deepest, 
and has an irregular quadrilateral form : it is rough, but is not covered 
with cartilage. It contains much articular fat. The synovial capsule 
adheres but slightly in this place, and is separated from the bone by 
layers of fat. 

III. ROUND LIGAMENT. 

§ 948. Directly before the portion of the synovial membrane which 
passes on the space below the bridge formed by the cartilaginous lip, 
arises a quadrangular ligament about an inch long, called the round 
ligament of the femur (Lig- ossis femoris teres s. rolundum). The ex- 
tremities of this ligament enlarge a little, and its outer end is attached 
to the bottom of the cavity in the head of the femur. It retains this 
bone more firmly in its situation. 

It is formed of longitudinal fibres, which are attached to the upper 
and lower horns of the cotyloid fissure and unite with the ligaments of 
the cartilaginous lip and also with the lip itself; but they are covered 
in all their circumference by a sheath of synovial membrane, which is 
reflected on itself. 

This ligament prevents the luxation of the femur upward, outward, 
and downward, as it prevents the femur from escaping in that direction : 
it is at least necessarily broken when this dislocation takes place, 
although the femur can quit the cotyloid cavity forward without its 
being ruptured. 

§ 949. The round ligament is sometimes deficient, either primitively 
or from a violent and often repeated compression of the ilio-femoral joint. 

IV. FIBROUS CAPSULE. 

§ 950. The fibrous capsule (capsida fibrosa ossis femoris) is the 
strongest and most perfect of all in the body. It arises above from the 
circumference of the inferior edge of the outer face of the cartilaginous 
lip, unites very narrowly in its whole extent with the external face of 
the synovial capsule, and is attached to the lower extremity of the head 
of the femur exactly in that part where the outer part of the capsule is 
reflected to cover the neck of the bone. It is very strong at its upper 
external and anterior portion, is two or three lines thick, and is formed 
of several superimposed layers of longitudinal fibres. 

This capsule is protected by the adjacent muscles of the thigh ; 
although the tendons of the muscles are not connected with it. 



48 DESCRIPTIVE ANATOMY. 

From its upper, anterior and internal part arise several bands, which 
ascend obliquely toward the internal part of the anterior face ol the 
horizontal branch of the pubis and the anterior face of the obturator 
membrane, with the fibres of which they are blended. 



ARTICLE THIRD. 

OF THE ARTICULATION OF THE KNEE. 

§ 951. The knee-joint is the most complex articulation in the body; 
for the synovial capsule is not only strengthened externally by three 
fibrous ligaments, but the corresponding surfaces of the femur and tibia 
are attached within this capsule by strong fibrous ligaments, which are 
even their principal mode of union. From this arrangement, the knee- 
joint is also the strongest of all. What renders the joint more complex 
is, that the two bones are separated from each other by an interarticular 
cartilage. 

I. SYNOVIAL MEMBRANE. 

§ 952. The synovial membrane (membrana sijnovialis articuli genu) 
arises some lines before the cartilage of the articular surface of the 
femur, and backward from directly above this same cartilage. It is 
attached below to all the circumference of the rough edge of the upper 
articular cartilaginous surface of the tibia. 

Its upper and lower faces unite with the cartilages which cover the 
articular surfaces of the two bones. A part of its anterior face covers 
also the posterior face and the lateral edges of the patella ; so that the 
patella slightly projects within the cavity. 

Beside, its upper and anterior portion covers rather closely the lower 
part of the extensor muscle of the leg, from which however it may be 
separated more easily than from the bone. The rest is united to the 
adjacent parts only by a very loose mucous tissue. 

The lower part of the cavity which it thus forms is divided into a 
right and a left portion ; because a perpendicular fold is formed, which 
is loose upward and extends from the posterior intercondyloid fossa of 
the femur to the anterior part of its circumference behind the ligament 
of the patella, and which is attached in this place below the patella 
itself. 

We find considerable accumulations of articular fat in many parts, 
especially on the anterior wall, around the patella, in the fold we have 
mentioned, and behind the condjdes of the femur. 

The whole capsule is very broad and loose, especially at its anterior 
part; less so however on the sides, which must be ascribed to the nature 
of the motions of the leg, which are only flexion and extension. 



SYNDESMOLOGV. 49 

The outer face of the synovial membrane is strengthened behind by 
oblique fibres, which descend from the external condyle of the femur to 
the internal condyle of the tibia. 

II. EXTERNAL FIDROUS LIGAMENTS. 

§ 953. On the circumference of the synovial membrane we find an 
internal and two external lateral fibrous ligaments. 

I. INTERNAL LATERAL LIGAMENT. 

§ 954. The internal lateral ligament (Lig. laterale internum) is the 
strongest, and is formed of perpendicular fibres. It descends from the 
anterior part of the internal face of the inner condyle to the upper part 
of the internal face of the tibia, where it is attached. It is broader above 
than below and is triangular, the base of the triangle being turned for- 
ward. It prevents the articular surfaces from being dislocated inward. 

II. LONG EXTERNAL LATERAL LIGAMENT. 

§ 955. The long, anterior, or external lateral ligament (Lig. genu 
laterale externum, s. longum, s. anlcrius) forms an oblong, rounded, firm 
band. It is situated before the short ligament, between the lower ex- 
tremity of the external condyle, from the external face of which it arises 
below, and the anterior part of the external face of the head of the fibula, 
to which it is attached. 

III. SHORT EXTERNAL LATERAL LIGAMENT. 

§ 956. The short external or posterior lateral ligament {Lig. genu 
laterale externum by-eve s. posterius) is still feebler than the preceding. 
It arises a little above, and half an inch behind it, from the inferior part 
of the posterior face of the external condyle of the femur, goes a little 
obliquely from above downward and from within outward, and is attached 
to the summit of the head of the tibia, higher than the preceding. 

The two external lateral ligaments prevent the luxation of the knee- 
joint outward. The terms anterior and posterior are more convenient 
than those generally used, as the length of both is the same or nearly 
the same. 

III. INTERNAL FIBROUS OR CRUCIAL LIGAMENTS. 

§ 957. The crucial ligaments (Lag. cruciata genu) are the strongest 
of all the connections between the femur and the tibia. We find two, 
an anterior and & posterior. 

The posterior is longer, broader, and stronger than the other, and its 
lower part is thicker but narrower than the upper part. It extends 

Vol. II. 7 



50 DESCRIPTIVE ANATOMY. 

from the posterior extremity of the depression between the two condyles 
of the tibia, toward the anterior extremity of the posterior lntercondy- 
loid fossa, at the internal face of the external condyle of the femur, 
where it is attached by a semicircular edge. Its direction is from below 
upward, from behind forward, and from within outward. 

The anterior arises from the anterior extremity of the internal point 
on the upper articular face of the tibia, goes outward, upward, and 
backward, crosses the preceding but does not touch it, and is attached 
a little behind it to the internal face of the outer condyle of the femur. 

These ligaments unite the tibia to the femur firmly, and also limit 
the turning of these bones on their axes. The posterior opposes the 
rotation of the thigh outward and that of the leg inward, while the 
anterior prevents the rotation of the thigh inward and that of the leg 
outward. 

IV. SEMILUNAR CARTILAGES. 

§ 958. The semilunar or falciform cartilages (cartilagines interar- 
ticulares genu semilunares, s.falcatm) derive their name from their form. 
Both are broader behind than before : the external edge which is con- 
vex, is much thicker than the internal which is concave and terminates 
obliquely in a point. The first adheres intimately to the synovial cap- 
sule, while the second is entirely loose ; but their two extremities are 
attached by a strong fibrous Hgament to the posterior part of the inter- 
condyloid fossa of the tibia. Another strong transverse ligament unites 
them at their anterior extremities. Their inferior faces are plain, but 
their superior are concave to a greater or less extent, and pointed near 
the two extremities. Each rests on one of the portions of the cartila- 
ginous face of the tibia, and corresponds to one of the condyles of the 
femur. They are separated by the eminence on the upper articular 
face of the tibia, and their concave edges are turned toward each other. 

The external falciform cartilage is uniformly broader than the inter- 
nal in its whole extent, and also a little larger ; hence it covers more of 
the upper face of the external condyle of the tibia. Its posterior extre- 
mity is very firmly attached to the fossa placed behind the spine of the 
tibia. It is also attached to the femur by a very strong ligament which 
arises more posteriorly, ascends obliquely from without inward between 
the two crucial ligaments, and is inserted directly behind the posterior, 
on the internal face of the internal condyle of the femur. Its anterior 
extremity, which is reflected from before backward behind the anterior 
articular ligament of the two cartilages, is attached to the anterior part 
of the depression before the spine of the tibia, directly behind the lower 
extremity of the anterior crucial ligament. 

The internal falciform cartilage is attached by its posterior extremity 
farther inward and backward than the external, directly before the 
posterior crucial ligament, at the posterior extremity of ihe depression 
placed behind the spine of the tibia, much farther forward and outward 
than the external. 



SYNDESMOLOGV. 51 

These two cartilages elevate the edge of the upper articular sur- 
face of the tibia, and thus impede the gliding of the condyles of the 
femur ; but they prevent particularly the compression of the femur and 
the tibia in the motions of the leg. 

§ 959. Of all the joints, the articulation of the knee is the most sub- 
ject to morbid alterations of texture, although it is not often dislocated, 
since the arrangement and firmness of its fibrous ligaments admit of but 
slight motions. 

In this particularly, above all other articulations, abnormal bones and 
cartilages are developed, which are at first attached to the synovial 
membrane by thin peduncles, but which in time are detached and 
isolated. 

This articulation is also almost the only one exposed to fungus of 
the joints (fungus articulorum). 

These conditions depend, partly on its great size, or partly on its 
position, as it is exposed to mechanical injury and compression more 
than any other joint. 



ARTICLE FOURTH. 

OF THE ARTICULATIONS OF THE BONES OF THE LEG. 

§ 960. The bones of the leg are attached to each other at their 
upper, middle, and lower portions. 

I. UPPER ARTICULATION. 

§ 961. The upper articulation of the two bones of the leg is formed 
by a short synovial membrane, the capsule of the head of the fibula 
{Lag. capituli fibuloz), which arises some lines above the head of the 
cartilaginous lateral articular facet of the tibia, and below the upper 
articular facet of the fibula, and the anterior face of which especially is 
strengthened by very strong transverse fibres, which extend from the 
internal edge of the head of the fibula to the external face of the upper 
extremity of the tibia. 

II. MIDDLE ARTICULATION. 

§ 962. The middle articulation is formed by the interosseous liga- 
ment (Lig. interosseum, s. membrana interossea). This ligament is 
thin and smooth ; it gradually contracts from above downward, and is 
formed of oblique fibres, which descend from the external edge of the 
tibia to the crest of the fibula. 

At its upper part we see a foramen, through which the anterior tibial 
vessels and nerves pass, and another below for the peroneal artery. 
We also occasionally see in all its extent similar but smaller openings. 



52 DESCRIPTIVE ANATOMY. 

It is situated between the flexor and the extensor muscles of the leg ; 
the fibres of which arise in part from its two faces. 

III. INFERIOR ARTICULATION. 

§ 963. Between the inferior extremities of the tibia and fibula a very 
narrow slip of the synovial membrane of the articulation of the foot 
extends in the form of a cul-de-sac, but there is no special articular 
capsule. This slip is attached by three broad fibrous bands. 

I. ANTERIOR TIBIO-PERONEAL LIGAMENT. 

§ 964. The anterior tibio-peroneal ligament (Lig. tibio-Jibulare ante- 
rius) arises from the external part of the anterior face of the lower ex- 
tremity of the tibia, and is attached to the inner part of the anterior 
face of the external malleolus. It is formed of fibres which descend 
obliquely from within outward. 

II. POSTERIOR TIBIO-PERONEAL LIGAMENT. 

§ 965. The posterior tibio-peroneal ligament (Lig. tibio-Jibulare 
posterius) is formed of fibres which follow the same direction as those 
of the preceding ; they extend from the external part of the posterior 
face of the inferior extremity of the tibia to the internal part of the 
posterior face of the external malleolus. 

III. SUPERIOR TIBIO-PERONEAL LIGAMENT. 

§ 966. The superior iibio-perone al hgament (Lig. tibio-Jibulare supe- 
rius) is formed of fibres similar to, but much shorter than the two pre- 
ceding, and extends from the external face of the tibia to the internal face 
of the fibula, directly above the inferior processes of these two bones. 

§ 967. A division of the anterior (§ 963) and of the posterior (§ 664) 
ligament into two portions, an upper and a lower, is useless, and 
does not naturally exist. 



ARTICLE FIFTH. 

OF THE ARTICULATION OF THE FOOT. 
I. SYNOVIAL CAPSULE. 

§ 968. The synovial capsule of the joint of the foot (membrana urti- 
cuh pedis synovialis) arises from the edge of the articular and cartila- 
ginous fare of the artioulation of the tibia and fibula, and from the cor- 
respondmg face of the astragalus. It blends with all these surfaces 
and sends a slip between the tibia and the fibula (§ 963). It is every 
where very loose, but loosest at its external part. 



SYNDESMOLOGY. 53 



II. FIBROUS LIGAMENTS. 



§ 969. The synovial capsule is covered forward, backward, and on 
the sides, by several bands, which do not unite in a fibrous capsule, 
and which extend from the tibia and fibula to the astragalus and cal- 
caneum. 

I. ANTERIOR LIGAMENTS. 

§ 970. "We may admit two anterior ligaments, an internal and an 
external. The central part of the anterior wall of the synovial capsule 
being loose, its two ligaments are much thinner than the others. 

The internal anterior ligament (Lig. anterius internum) is composed 
of perpendicular fibres, some of which ascend a little obliquely outward. 
It is larger than the external, and goes from one part of the anterior 
edge of the lower articular face of the tibia to the back of the scaphoid 
bone. 

The external anterior ligament {Lig. anterius externum) arises from 
the anterior part of the outer face of the external malleolus, and being 
formed of oblique fibres, proceeds from without inward and from behind 
forward, and is attached to the outer part of the anterior face of the 
body of the astragalus. It is usually formed of two bands, situated one 
at the side of the other, and separated by an interval. The upper band 
is much larger than the lower. The whole ligament has an irregular 
quadrilateral form. 

II. POSTERIOR LIGAMENTS. 

§ 971. Usually there are two posterior ligaments, one superficial 
and the other deep. The superficial posterior ligament (Lig. posterius 
superficial) has an elongated cylindrical form, and extends from the 
internal edge of the external malleolus, below the insertion of the pos- 
terior tibio-peroneal ligament, to the centre of the posterior edge of the 
body of the astragalus, where it is attached to an eminence of this 
bone. Usually, a special and smaller band is detached from this point, 
which unites to the preceding, but goes in a contrary direction down- 
ward and outward, to be inserted in the upper part of the internal face 
of the tuberosity of the calcaneum. 

The- deep posterior ligament (Lig. posterius profundum) is much 
stronger than the preceding, and is separated from it by fat and cellu- 
lar tissue. It rests directly on the posterior wall of the synovial cap- 
sule, and is formed of longitudinal and oblique fibres, which arise from 
the posterior edge of the lower articular face of the tibia, and from the 
under part of the inner face of the external malleolus. These fibres 
converge and go downward, and are inserted above the preceding liga- 
ment in the posterior face ofthe body of the astragalus. 



54 DESCRIPTIVE ANATOMY. 



Sometimes the two ligaments are blended together. 

The fibres which come from the fibula are always the strongest. 



III. LATERAL LIGAMENTS. 

§ 972. The lateral ligaments are much stronger than all the other 
fibrous ligaments. 

A. EXTERNAL LATERAL LIGAMENT. 

§ 973. The external lateral ligament {Lig. laterale externum fibula 
rectum, s. perpendiculare, s. medium, s. triquetrum) is much longer from 
above downward than from before backward, and gradually enlarges 
in the first direction. It extends from the summit of the internal mal- 
leolus to the external face of the calcaneum, to which it is attached, 
after dividing into an anterior and a posterior fasciculus. 

B. INTERNAL LATERAL LIGAMENT. 

§ 974. The internal lateral ligament, called generally the triangular 
ligament, and which might be called the trapezoid (Lig. laterale inter- 
num deltoides, trapezium), goes from the inferior edge of the internal 
malleolus to the internal faces of the astragalus and calcaneum. It is 
more broad than high, is lower than the external, but is broader and as 
strong. It blends with the inner anterior ligament forward, and with 
the internal portion of the deep posterior ligament backward. 



ARTICLE SIXTH. 

OF THE LIGAMENTS OF THE TARSUS. 

§ 975. All the bones of the tarsus are confined by short and thick 
synovial capsules, over which in many parts fibrous ligaments are 
extended. The latter are divided into those of the back, of the sole, of 
the tibial and fibular edges of the foot. 

I. LIGAMENTS OF THE POSTERIOR RANGE. 
I. SYNOVIAL CAPSULE. 

§ 976. The two bones of the posterior range are united by two 
synovial membranes, a proper and a common. 

The proper synovial capsule (capsula propria aslragalo-calcanea) 
arises below from the edges of the upper and cartilaginous face of the 
body of the calcaneum, extends a little backward, over the portion of 
this same face, which is not cartilaginous, and is attached above to the 
corresponding circumference of the cartilage on the cartilaginous infe- 
rior face of the body of the astragalus. 



SYNDESMOLOGY. 55 

The common synovial capsule (capsula communis, s. astragalo-calca- 
neo-scaphoidea) will be described hereafter. It is situated between the 
upper cartilaginous face of the anterior process of the calcaneum and 
the lower face of the head of the astragalus. 

II. FIBROUS LIGAMENTS. 

§ 977. The two synovial capsules are strengthened in several parts 
by fibrous ligaments, and the proper capsules particularly by the lateral 
and the posterior ligaments of the articulation of the foot (§ 971). 

Besides, a broad internal ligament extends from the internal part of 
the posterior face of the body of the astragalus, to the posterior part of 
the internal face of the calcaneum, and is called the internal and pos- 
terior asiragalo-calcanean ligament (Lig. astragalo-calcaneum inter- 
num, s. posterius. 

The anterior face is confined by an internal . and an external liga- 
ment. 

The internal anterior astragalo-calcanean ligament {Lig. astragalo- 
calcaneum internum antcrius) extends from the internal extremity of 
the cartilaginous surface of the anterior process of the calcaneum to 
the internal face of the astragalus. 

The external astragalo-calcanean, or interosseous ligament (Lig. 
astragalo-calcaneum externum, s. interosseum) is composed of five or six 
very strong fasciculi, which are situated behind one another, and which 
diminish in length very much from behind forward and also from with- 
out inward. These fasciculi go from the external rough part of the 
upper face of the anterior process of the calcaneum to the external face 
of the neck and head of the astragalus, and to the channeled and acar- 
tilaginous part of the inferior face which separates the upper faces of 
the body and the anterior process. They fill the large space between 
these two bones. 

II. OF THE LIGAMENTS BETWEEN THE ANTERIOR AND THE POSTERIOR 

RANGE. 

I. SYNOVIAL CAPSULES. 

§ 978. There are two synovial capsules, one lor the astragalus, i lie 
calcaneum, and the scaphoid bone ; the other for the calcaneum and the 
cuboid bone. 

The first, or the aslr'agalo-calcaneo-scaplwid capsule, has already 
been mentioned (§ 976). It arises from the margin of the anterior 
articular face of the astragalus, forms a cul-de-sac backward, which 
is reflected on the upper articular face of the anterior process of the 
calcaneum, and goes to the circumference of the posterior articular 
face of the scaphoid bone, and is blended with lis posterior cartilaginous 
face. 



56 DESCRIPTIVE ANATOMY. 

The proper, or the cakamo-cuboid capsule (capsuta synovialis cal- 
caneo-cuboidea), extends between the corresponding articular laces 
of these two bones. 

II. FIBROUS LIGAMENTS. 

§ 979. The astragalus and the calcaneum are united to the sca- 
phoid bone, and this latter to the cuboid bone by external fibrous 
ligaments. 

A. CALCANEO-SCAPHOID LIGAMENTS. 

§ 980. There arc two calcaneo-scaphoid ligaments {Lig. calcaneo- 
scaphoidea), a superior and an inferior. 

The superior is much weaker than the other, and arises from the 
anterior edge of the rough portion of the tuberosity of the calcaneum, 
and ascends obliquely from behind forward, and from without inward, 
where it is attached to the external extremity of the back of the 
scaphoid bone. 

The inferior, much stronger than the superior, being formed of 
several distinct bands, is more broad than long. It extends from the 
anterior edge of the tuberosity of the calcaneum to the external part of 
the inferior face of the scaphoid bone. It forms, conjointly with the 
calcaneum and scaphoid bones, a cavity for the head of the astragalus. 

B. ASTRAGALO-SCAPHOID LIGAMENT. 

§ 981. The astragalo-scaphoid ligament (Lig-. astragalo-scaphoi- 
deum) covers all the upper surface of the synovial capsule of the two 
bones. It is formed of thin fibres, the direction of which is from before 
backward. Some of these fibres proceed even to the cuneiform bones. 

C. CALCANEO-CUBOID LIGAMENTS. 

§ 982. The calcaneum is united to the cuboid bone by superior, 
external, and inferior ligaments. 

The superior ligaments (Lig. calcaneocuboidea superiora s. dor- 
salia) are usually three in number, placed successively from without 
inward. They form thin and flat bauds, winch increase progressively 
in length, from within outward, and arc situated between the upper 
edge of the articular face of the calcaneum and the same edge of the 
corresponding face of the cuboid bone. 

The external ligament (Lig. calcaneocuboideum externum s.fibidare) 
extends as high as the cartilaginous faces of the two bones, on the out- 
sides of which t hey are attached. It is also thin, but stronger than the 
superior. 

The inferior ligament (Lig. calcaneo-cuboidetw infer ius s. plantar e) 
maybe considered as formed by .three superimposed layers, each of 



SYNDESRIOLOGY. 57 

which is stronger than the other ligaments of these bones, and which 
unite to form one of the strongest fibrous ligaments of the tarsus, 
perhaps the strongest even in the whole body. 

The superficial layer, the longest and strongest, arises directly from 
the lower face of the tuberosity of the calcaneum, and is attached to all 
the tuberosity of the cuboid bone. 

The central layer is much shorter and narrower, and is not entirely 
covered on the inside by the preceding. We ought, properly speaking, 
to consider it as a continuation of the inferior calcaneo-scaphoid 
ligament (§ 980). It arises from the inner part of the anterior edge 
of the articular face of the calcaneum, and is attached behind to the 
internal part of the rough inferior face of the cuboid bone. 

The deep layer is entirely covered by the superficial ; but by the 
central layer, only at its internal part. It is formed of fibres which go 
more obliquely from without inward and forward. It arises from the 
same parts of the two bones, but a little more externally. 

III. LIGAMENTS BETWEEN THE BONES OF THE ANTERIOR RANGE. 
I. SCAPHOIDQ-CUBOID LIGAMENTS. 

§ 983. The scaphoid and cuboid bones are united, especially pos- 
teriorly, in their whole extent by the interosseous ligament (Lig. 
interosseum scaphoido-cuboidewri), the fibres of which are oblique, 
short, and very compact. We usually find a synovial capsule before 
this ligament. 

§ 984. The external fibrous ligaments are two : 

1st. The dorsal scaphoido-cuboid ligament {Lig. scaphoideo-cuboi- 
deum dorsale) which is square, and arises from fibres which extend 
obliquely from behind forward, and from within outward. It goes 
from the external edge of the scaphoid to the centre of the upper face 
of the cuboid bone. 

2. The plantar, Lig- scaphoideo-cuboideum plantar e) has the same 
form and direction as the preceding, but is composed of fibres which are 
more detached from each other : it extends from the centre of the 
inferior face of the scaphoid bone to the centre of the internal edge of 
the cuboid bone. 

II. LIGAMENTS BETWEEN THE SCAPHOID AND CUNEIFORM BONES. 

§ 985. The ligaments which unite the scaphoid to the three cunei- 
form bones, are a synovial capsule and fibrous ligaments. 

A. SYNOVIAL CAPSULE. 

§ 986. The synovial capsule is situated between the commencement 
of the anterior face of the scaphoid bone, and the posterior face of the 
three cuneiform bones. It also penetrates between the latter. 

Vol. II. 8 



58 



I I'ilVE ANATOMT 



B. FIBROUS LIGAMENT?. 



§ 987. a. The fibrous ligaments are, the dorsal, the internal, and the 
plantar. 

We may admit two dorsal ligaments (Lig. scaphoideo-cuboidea 
dorsalia), an internal and an external. 

The internal is triangular, and extends from the anterior and ex- 
ternal part of the upper face of the scaphoid bone to the upper face of 
the second cuneiform bone. Its fibres go forward and outward. 

The external is smaller than the other, from which it is entirely 
separated, is square, and formed of fibres which proceed in the same 
direction. It arises more externally, immediately at the side of the 
preceding, and is attached to the upper face of the third cuneiform bone. 
It is blended with the dorsal scaphoido-cuboid ligament (§ 984). 

b. A strong internal ligament, (Lig. scaphoideo-cuboideum internum), 
the fibres of which are straight and almost horizontal, extends from the 
anterior edge of the internal face of the scaphoid bone to the posterior 
part of the inner face of the first cuneiform bone, and unites these two 
bones in their whole extent. 

c. We may admit three plantar ligaments. The internal, the 
strongest is the continuation of the preceding, but is thicker than it. 
It is square, and its fibres which are straight, extend from the 
tuberosity of the scaphoid bone to that on the inferior face and the 
posterior edge of the first cuneiform bone. 

The central is feebler, but longer, and arises at the side of the pre- 
ceding a little more externally. It goes obliquely from before back- 
ward, and from without inward, to the posterior part of the inferior 
edge of the second cuneiform bone. 

The external, which is feebler and situated more deeply, is composed 
of detached, oblique, and transverse fasciculi. It extends from the 
external and anterior part of the inferior face -of the scaphoid bone, to 
the posterior extremity of the inferior edge of the second and third 
cuneiform bones. 



III. LIGAMENTS BETWEEN THE CUBOID AND CUNEIFORM BONES. 

§ 988. These ligaments are, a synovial capsule and two fibrous 
ligaments. 

The synovial capsule is situated between the cartilaginous points 
of the cuboid and of the third cuneiform bones. 

There are two fibrous ligaments, a dorsal and a plantar. 

a. The dorsal ligament, which is not constant, being often entirely 
replaced by the dorsal scaphoido-cuboid ligament (§ 984), when it 
exists, is very feeble, and is situated at the external edge of' this last : 
it is formed of longitudinal fibres, which extend from the back of the 
cuboid bone to the posterior extremity of the back of the third cuneiform 

bnne 



SYNDESMOLOGY. 59 

b. The plantar ligament is much stronger, and is formed of several 
distinct fasciculi, the anterior of which is the largest, and which all 
extend transversely from the internal edge of the plantar face, and from 
the lower part of the inner face of the cuboid bone to the inferior face 
and to the inferior part of the internal face of the third cuneiform bone. 

IV. LIGAMENTS? OW THE CUNEIFORM BONES. 

§ 989. 1st. The synovial capsules between the three cuneiform bones, 
arise from the common capsule between the scaphoid and the cuneiform 
bones (§ 986). 

2d. The fibrous ligaments are, 

a. The dorsal ligaments which form several feeble layers of oblique 
and transverse fibres, which extend from the first to the second, and 
from this to the third cuneiform bone. 

b. The interosseous ligaments, which are very firm transverse fibres, 
extend between the internal faces of the first and second, and of the 
second and third cuneiform bones, where there is no slip from the 
synovial capsule. 

c. The plantar ligaments are firm but isolated and usually oblique 
bands, which go from the posterior part of the internal face of the first 
cuneiform bone to the posterior extremity of the inferior edge of the 
second, and from this to the posterior extremity of the inferior edge of 
the third. They unite with the interosseous and plantar scaphoido- 
cuboid ligament. 



ARTICLE SEVENTH. 

OF THE LIGAMENTS BETWEEN THE TARSUS AND METATARSUS. 
I. SYNOVIAL CAPSULE. 

§ 990. The synovial membrane between the bones of the metatarsus 
on one side, the three cuneiform and the cuboid bones on the other, are 
not arranged in the same manner in all parts nor in all subjects. 

We however find a special synovial membrane between the anterior 
extremity of the first cuneiform bone and the posterior extremity of the 
first metatarsal bone. 

Usually, the second metatarsal bone is united to the three cuneiform 
bones by a common synovial capsule. 

We find a third synovial membrane between the third metatarsal 
and the third cuneiform bones. 

Finally, the fourth and fifth metatarsal bones are united to the cu- 
boid bone by a common capsule. 



60 DESCRIPTIVE ANATOMY. 



II. FIBROUS LIGAMENTS. 



§ 991. The fibrous ligaments which strengthen these synovial mem- 
branes are divided into dorsal and plantar. 

a. The dorsal form several square and thin bands, which go from 
the upper face of the bones of the metatarsus corresponding to the 
tarsal bones, to the posterior extremity of the latter. The fibres of the 
external are a little oblique from within outward and from behind for- 
ward ; those of the internal go directly from before backward. 

6. The plantar correspond to the dorsal : they are however, except 
the first, a little weaker. They are strengthened by the tendons of the 
tibialis anticus and posticus muscles. 

We see also strong fibrous bands, which go from some of the meta- 
tarsal to the tarsal bones which do not articulate with them ; for 
instance, from the base of the second and fourth metatarsal bones to 
the anterior extremity of the third cuneiform bone going directly from 
before backward, and from the plantar face of the posterior extremity 
of the fifth metatarsal bone, transversely, to the extremity of the third 
cuneiform bone. 

The posterior part of the circumference of the articulation of the first 
cuneiform bone with the metatarsal bone of the first toe is also furnished 
with strong ligamentous fibres, which go directly from before backward. 



ARTICLE EIGHTH. 

OF THE LIGAMENTS OF THE METATARSAL BONES AND 
PHALANGES. 

I. METATARSAL LIGAMENTS. 

I. POSTERIOR LIGAMENTS. 

§ 992. The metatarsal bones, except the first, have the corresponding 
faces of their posterior extremities covered by slips of the synovial mem- 
branes extended between them and the bones of the anterior range of 
the tarsus (§ 990). 

The fibrous ligaments resemble those of the metacarpus (§ 919-921). 
They are divided into dorsal, middle, and plantar . 

The upper or dorsal {lag. ossium metacarpi dorsalia) are formed of 
transverse fibres, which arise from the dorsal side of the corresponding 
faces of the posterior extremity of the adjacent bones. We find only 
three of them, because the metatarsal bone of the first toe does not arti- 
culate in this manner with the second. The upper ligament is how- 
ever here replaced by an analogous ligament, which extends from the 
first cuneiform bone to the base of the second metatarsal bone. 



SYNDESMOLOGY. 61 

The middle or interosseous ligaments (Lig. ossium metatarsi media 
.s. inter ossea) are sometimes only three in number, and proceed obliquely 
from above and inward to go to the next metatarsal bone : more fre- 
quently however there are four. Similar fibres exist also between the 
first and second metatarsal bones. 

The inferior or plantar ligaments {Lig. ossium metatarsi infcrioras. 
plantaria) are like the dorsal, only three in number, and are the 
strongest. The ligament between the first and second metatarsal bone 
becomes a very strong fibrous layer, which extends from the first cunei- 
form bone to the second and third metatarsal bones. 

The fibres of this very long ligament proceed in a direction opposite 
to that of those between the fourth and fifth metatarsal bones ; that is, 
the former go from behind forward and from within outward, the latter 
from without inward and from behind forward, so that they converge 
anteriorly. 

II. ANTERIOR LIGAMENTS. 

§ 993. On the plantar face between the anterior extremities of all 
the metatarsal bones, are very strong square ligaments, formed of lon- 
gitudinal fibres, which are attached to the synovial capsules rather than 
to the bones. These are called the anterior metatarsal ligaments (Lig. 
metatarsi anteriora plantaria). 

II. LIGAMENTS OF THE TOES. 

§ 994. Synovial capsules, with lateral and inferior fibrous ligaments, 
exist between the posterior phalanx of each toe and the corresponding 
metatarsal bone, and also between the different phalanges. The final 
phalanges also have ungual ligaments. These parts being similar to 
those of the hand (§ 922-927), it is unnecessary to describe them. 



62 DESCRIPTIVE ANATOMY. 

BOOK III. 

OF MYOLOGY. 

§ 995. The general characters of the muscles(l) have been men- 
tioned in the first volume. We shall here describe only the voluntary 
muscles, and not all even of these ; but shall confine ourselves to those 
which move the bones ; the history of all the others being placed more 
conveniently after the description of the parts which they move, with 
which we must first be acquainted if we wish to have an exact idea of 
the attachments of the muscles and of their modes of action. The sys- 
tem of the involuntary muscles is distributed in the vascular system 
and the viscera, in describing which also they will be examined. 

§ 996. We consider as single muscles all those parts of the mus- 
cular system which can be separated from each other without dividing 
the fibres. In this manner we count in the normal state two hundred 
and thirty-eight different muscles, six of which are unmated and com- 
posed of two parts which unite on the median line, and two hundred 
and thirty-two are in pairs ; so that the whole number of the muscles 
is four hundred and seventy. 

The nomenclature of these muscles is not uniform : for a long time 
the inconvenient method of numbering them was used. It is, however 
equally inconvenient to establish 'a uniform principle of nomenclature 
in myology, by changing the names of the muscles into descriptions 
of their situations and attachments, as Dumas and Chaussier have 
done ; for then the extremely long and very complex names resemble 
each other too much. 

The muscles derive their names principally from their modes of 
action, their attachments, their form, and their volume. 

(1) Among 1 the descriptions we shall mention : Stenon, Elementorum myologice 
specimen, Amsterdam, 1669. — Doug-las, Myographies comparatce specimen, Leyden, 
1729. — Garengeot, Myologie humaineet canine, Paris, 1728. — Albinus, Historia mus- 
culorum hominis, Leyden, 1734. — Duverney, I' Art de dissequcr methodiquement les 
muscles du corps humain, Paris, 1749. — G. F. Petersen, Grundliche Anwiesung zu 
der Zergliederung der Muskeln des menschlichen Kbrpcrs, Hamburg, 1 763. — J. Innc9, 
A short account of the human muscles, Edinburgh, 1788. — J. G. Walter, Myologisches 
Handbuch, Berlin, 1777. — Sandifort, Descriptio musculorum hominis, Leyden, 1781. — 
Gavard, Traite de myologie suivant la methode de Desau.lt, Paris, an vii. — Fleisch- 
mann, Anleitung zur Kenntniss der Muskeln des menschlichcn Kbrpers, Erlangen, 
1811.— The principal plates are: G. Cowper, Myotomia reformata, London, 1724.— 
Myologie complete en couleur ct de grandeur naturelle, Paris, 1746. — Albinus, Tabu- 
Ice sceleti et musculorum corporis humani, Leyden, 1747.— Duverney, Tabulce anato- 
micce, 1748. — G. G. Muller, XII. Kupfertafeln welche die meisten kleinen und zartcn 
Muskeln des menschlichen Kbrpers vorstellen, Erfort, 1755. — J. Innes, Eight anato- 
mical tables of the human body, containing the principal parts of the skeleton, muscks, 
etc., Edinburgh, 1776.— J. Bell, Engravings explaining the anatomy of the bones,mus- 
cles, and joints, London, 1809.- -Lewi?, Views of the muscles of the human body, Lon- 
don, 1820. 



MYOLOGY. ,63 

For the same reason that we commenced in osteology by describing 
the vertebral column, we shall mention first the muscles of the trunk, 
then those of the head, and lastly those of the extremities. 

These three large divisions of the body, from the great number of 
their muscles and the different layers that they form, are usually sub- 
divided into a greater or less number of regions (regiones), which mo- 
dern writers have too extensively multiplied, by insulating the descrip- 
tions of the different muscles and by disregarding undoubted analogies. 

When about to describe the muscles, a great difficulty presents itself 
relative to the order which we should adopt. Must we follow the 
anatomical order, which regards only the situation and the manner in 
which the different layers succeed each other 1 or the physiological 
order, which is founded on their action, so that those muscles which 
should be considered together or immediately after each other, according 
to the first method, are separated from each other and allied on the con- 
trary to others, which the anatomical order would separate from them % 
Thus, for instance, many of the muscles which move the upper extre- 
mities are muscles of the back if we consider their situation ; so that 
they are generally referred to this region. The custom of considering 
the muscles according to their situation and the order in which they 
succeed each other is also proper ; since it presents all their relations 
more exactly and allows us to demonstrate the different layers in the 
presence of the pupil. This then is the order which we shall adopt, 
always however with the proviso mentioned above (§ 995). 



SECTION I. 

OF THE MUSCLES OF THE TRUNK. 

§ 997. The muscles of the trunk are divided into those which move 
the different bones of the trunk and head, and into those which go from 
the trunk to the first two divisions of the upper limbs : the latter, although 
they do not act on the bones of the trunk, deserve to be considered in 
this place, because many of them form the external layers of the mus- 
cles situated on the trunk and cover the others. The best method of 
classing them is to make two series : 

1. The posterior muscles of the trunk, or the muscles of the back and 
the posterior muscles of the neck. 

2. The anterior muscles of the trunk, or the muscles of the abdomen, 
of the thorax, and of the anterior part of the neck. 



64 DESCRIPTIVE ANATOMY. 

CHAPTER I. 

MUSCLES OF THE BACK. 

§ 998. The muscles situated on the posterior part of the trunk, or 
on its dorsal side (musculi dorsales), form several superimposed layers, 
which are four in number and which differ in their attachments and 
also in their modes of action. The external muscles are for the most 
part larger, but they are fewer. They cover the other muscles of the 
back and belong to the class of the broad muscles. Those below them 
are more oblong ; most of them are short, especially those situated 
most deeply. Some are composed of several short separate bellies. 

In regard to the functions and attachments of these muscles, we may 
say, that most of them belong to the vertebrae, the head, and the ribs ; 
for but few are attached to the bones of the upper extremities. 

The superficial belong to the second section and the deep-seated to 
the first. 

The direction of the fibres is not the same in all. In some for instance, 
as the trapezius and the latissimus dorsi, it varies in the different 
regions. But in most of the others it is the same every where. We 
may remark generally, that no muscle of the back is composed entirely 
of longitudinal fibres, which are found only in the centre of the trape- 
zius and in the upper part of the latissimus dorsi. The fibres of all the 
others are more or less longitudinal. The latter may be referred to 
three classes. 

First, those which ascend in a straight line and which move the 
parts in that direction. These are the sacro-lumbalis and longissimus 
dorsi muscles, the cervicalis decendens, the interspinals and their cor- 
responding muscles, the rectus capitis posticus major and minor, the 
intertransversarii, and the lateral muscles of the head, which cor- 
respond to them ; these may be called the straight muscles of the back 
(JVf. dorsales recti). 

Second, those which descend obliquely outward ; some arise from 
the spinous processes, and are attached to the transverse processes of 
the lower vertebrae, to the ribs, or to the scapula ; others proceed from 
the transverse processes and go to the scapula or to the ribs ; finally, 
some proceed from one rib to the following. We may call them the 
descending oblique muscles (M. dorsales obliqui descendentes) from 
their analogy to abdominal muscles ; these are, considering them from 
without inward, the levator scapulre, the rhomboidei, the serratus ami- 
cus and posticus, the complexus, the digastricus, the spinales colli, the 
semispinales dorsi, the multifidus spinas, the obliquus capitis superior, 
the supracostales, the scaleni, and the intercostales externi. 

Third, those which descend obliquely outward, or the ascending 
oblique muscles {M. obliqui dorsales ascendentes). They extend 
either from the transverse to the spinous processes, or from the internal 



MYOLOGY. 65 



part of these latter to the bones situated more externally. They are, 
considering- them from the surface internally, the splenii, the serratus 
posticus inferior, the transversalis, the complexus colli, and the obliquus 
capitis infeiior muscles. 



ARTICLE FIRST. 

MUSCLES OF THE FIRST, SUPERFICIAL, OR EXTERNAL LAYER. 

§ 999. The external layer is composed of two muscles, the trapezius 
and the latissimus dorsi, which are attached not only to the bones of 
the trunk and which serve principally to move the upper extremities. 

I. TRAPEZIUS. 

§ 1000. The trapezius muscle, Dorso-sus-acromien, Ch. (M. cucul 
laris, s. trapezius) is so called from its position and its figure when 
united to that of the opposite side. In fact each of these muscles has 
an inequilateral triangular form, the base of which looks inward. They 
unite on the median line, from the centre of the squamous portion of 
the occipital bone to the last dorsal vertebra, so that they cover the 
region of the neck, the back, and the shoulder. This muscle at its 
lower part is still more superficial than the latissimus dorsi, the upper 
and inner part of which it covers. 

This broad, flat, and thin muscle arises, first, from the external occi- 
pital protuberance, and from a greater or less portion of the upper 
curved line of the occipital bone, and rarely also from the mastoid pro- 
cess of the temporal bone ; second, from the cervical ligament, where 
it blends with that of the opposite side ; third, from the spinous pro- 
cesses of the last cervical, and of the eighth, ninth, tenth, eleventh, 
and twelfth dorsal vertebra, also from the interspinal ligaments, where 
the muscles of the two sides meet. The fibres which come from this 
last point have in general a very short tendon, except at the centre and 
at the inferior extremity. 

The muscle is attached to the posterior edge, and to the upper face 
of the external or posterior part of the clavicle, to the acromion process, 
and to almost all the loose edge of the spine of the scapula. 

The upper fibres descend obliquely from behind forward and from 
within outward, the centre are longitudinal, and the inferior ascend 
from within outward ; it is much thicker at its upper than at its lower 
part, and is broadest in the centre. Its fixed point is the vertebral 
column, so that it acts principally on the scapula and clavicle, which 
it draws upward by its upper part; inward, backwn id, and from the 
side of the opposite shoulder, by its central part ; below and inward by 
the lower portion. When all its parts contract simultaneously, it draws 

Vol. II. 9 



G6 DESCRIPTIVE ANATOMY 

these bones, and with them the whole upper extremity, backward. Its 
upper portion also draws the head backward and bends the neck. 



II. LATISSIMUS DOHSI. 



§ 1001. The latissimus dorsi muscle, Lombo-humeral, Ch. occupies 
the lower part of the back and the whole lumbar region. Its form is 
triangular, and it arises from the summit of the spinous processes of 
from four to eight of the lower dorsal, of all the lumbar and of the 
sacral vertebrae, from the transverse processes of the sacrum, where it is 
continuous with the glutaeus maximus muscle, and from the outer lip of 
the central portion of the crest of the ilium, by a tendon which gradu- 
ally enlarges from below upward, and finally becomes very large ; and 
lastly, from the external face of the four lower ribs, near their anterior 
extremity, by four fleshy digitations, between which the lower digita- 
tions of the obliquus abdominis externus muscle are situated. It is 
attached by a strong tendon to the posterior lip of the bicipital groove 
of the humerus, directly behind its small tubercle, so that it forms the 
external wall of the hollow of the axilla. The centre of its upper 
edge covers the inferior part of the scapula, and it is usually strength- 
ened in this place by a strong fasciculus, which arises from the inferior 
angle. 

The tendon of the latissimus dorsi turns from below upward and from 
behind forward on the inferior edge of the teres major muscle, with 
which it is for the most part united. But towards its extremity 
they most generally separate, and a large bursa mucosa exists between 
them. At its point of insertion it unites slightly with the tendon of the 
pectoralis major muscle. Toward its internal extremity, the inferior 
edge of its tendon sends a tendinous band to the brachial aponeurosis. 
A second is detached from its posterior face and goes to the small tu- 
bercle of the humerus. 

The latissimus dorsi is very thin in its inner part, especially at its 
upper portion, but gradually increases in thickness from within outward 
and is finally considerably thick. Its upper fibres are longitudinal and 
the lower ones are oblique ; the latter become straighter as they arise 
more externally, and are finally almost perpendicular. This muscle 
acts principally on the upper extremities which it draws downward and 
backward ; hence the obscene but very significant term anilersor or 
aniscalptor. When however the upper extremity is fixed, it will draw 
the ribs to which it is attached upward and outward, so that it acts 
whenever respiration is very much impeded. Farther, it will under 
the same circumstances move the trunk upon the upper extremity, and 
raise or bend it. 

§ 1002. A fleshy or tendinous band not unfrequently (about once in 
thirty times) detaches itself from the upper part of the latissimus dorsi, 
before the coraco-brachialis muscle, and goes to the posterior face of the 
tendon of the pectoralis major muscle, to which it is attached. This 
peculiar arrangement, which is found in the normal state in the mole 



MYOLOGY. 67 



and in birds, renders the brachial vessels and nerves very liable to com- 
pression^ 1) Sometimes also, but more rarely, a similar band goes to 
the coracoid process of the scapula, where it unites with the upper 
extremity of the coraco-brachialis muscle. (2) 



ARTICLE SECOND. 

MUSCLES OT THE 8ECOND LAYER. 



§ 1003. The second layer is formed by the rhomboidei, the levator 
anguli scapulae, the splenii, and the serrati muscles, which partially or 
wholly cover each other. All are thin and vary in length and breadth. 



RHOMBOIDEI MUSCLES. 



§ 1004. The rhomboidei muscles, Dorso-scapulaire, Ch. are the most 
superficial; they occupy most of the space between the vertebral 
column and the scapula. 



A. RHOMBOIDEUS MAJOB. 



§ 1005. The rhomboideus major or the inferior rhomboid muscle 
arises by short tendons from the lateral part of the summits of the spi- 
nous processes of the four, and sometimes of the five, upper dorsal ver- 
tebras, sometimes even of the last cervical vertebra, and is attached to 
most of the external lip of the base of the scapula, from its triangular 
surface to near its inferior angle. Its fibres are parallel, and go ob- 
liquely outward and downward. 



B. BHOMBOIBEUS MINOR. 



§ 1006. The rhomboideus minor or superior rhomboid muscle is 
situated directly above the preceding, and is sometimes blended with 
it. It is about one fourth the size of it. It' arises from the first dorsal 
and from the seventh and sometimes the sixth and fifth cervical verte- 
bras, and is attached, its fibres having the same direction, to that part 
of the base of the scapula which the preceding does not occupy. At 
its origin, it is at first blended with the serratus magnus muscle which 
passes over it. 

The uses of these muscles are nearly the same ; they draw the sca- 
pula upward and backward, and consequently act in shrugging the 
shoulders. 

(1) Wardrop, in the Edin. Med. Journ. vol. viii. p. 282.— Kelch, Beytrage zur pa- 
thologischen Anatomic, 1813, p. 34, Berlin. — We have also seen this anomaly. 

(2) Rosenmuller, var. muse. p. 5.— Kelch, loc. cit. p. 35. We have seen this variety 
also. 



GS DESCRIPTIVE ANATOMV. 



II. LEVATOR ANGULI SCAPULAE. 



§ 1007. The levator anguli scapulae muscle, Trachelo-scapulaire 
Ch. (M. levator scapula}, s. anguli scapula;, M. patientice) is situated 
behind and on the side of the neck, over the rhomboidei muscles. It is 
longer, but thicker and more rounded than these muscles. It arises 
from the posterior tubercle of four, and more rarely of three or five, of 
the upper cervical vertebra, by as many digitations, which are at first 
tendinous, generally very long, and which, especially the first, remain 
distinct through the whole length of the muscle. These digitations, 
the first of which is much the strongest, unite in a common belly, 
which descends obliquely backward and outward, and is attached by 
short tendinous fibres to the upper angle of the scapula. It is rare to 
find only two digitations which are attached to the first two vertebrae ; 
however we have once observed this arrangement which was perfectly 
symmetrical on both sides ; at the same time, the levator scapula? was 
completely divided into two muscles, an internal above, an external 
below ; the latter was inserted in the commencement of the spine. 

This formation is similar in more than one respect to what is seen 
in animals : in fact, in most mammalia, the levator anguli scapulae 
muscle has but two or three digitations, which are always attached to 
the upper cervical vertebra, seldom to the occipital bone. On the 
other hand, in apes this muscle is inserted into the spine of the scapula, 
and in the dolphin covers the surface of this bone. 

Its upper tendons are blended with those of the splenius colli and of 
the cervicalis descendens. In its course it lies above the splenius mus- 
cle and is covered below by the trapezius. 

This muscle corresponds in its situation and its action to the rhom- 
boidei muscles, of which we recognize that it is only a repetition when 
we find it divided into several bellies, each of which is attached to 
but one vertebra. 

It draws the upper angle of the scapula upward, but at the same 
time turns it round its axis, and depresses the region of the shoulder 
when it acts alone ; so that it is the antagonist of the trapezius and 
serratus magnus muscles. When it contracts at the same time with 
the rhomboidei and trapezius, the shoulder is directly elevated. When 
the upper extremities are fixed, it draws the neck to its side, if only one 
muscle acts ; but if both contract, the neck is fixed and kept straight. 

§ 1008. Sometimes a long slip is detached from this muscle, which 
goes between the scapulae and the vertebral column, an arrangement 
similar to what is seen in the dolphin. 

HI. SERRATI MUSCLES. 

§ 1009. The posterior serrati muscles (M. serrati, s. denlati poslici 
superior et inferior) form in fact but a single muscle,since they are united 



MYOLOGY. 69 

by an aponeurotic expansion. Both arise from the spinous processes of 
the vertebrae, and are attached to the ribs. The inferior is covered by 
the latissimus dorsi, the upper by the trapezius and the rhomboidei 
muscles ; both are broad and thin. They are both square, and are 
attached by several digitations to the ribs. 

A. SEBBATUS POSTICUS 6UPEBI0B. 

§ 1010. The serratus posticus superior muscle, Dorso-costal, Ch., 
usually arises by a broad tendon from the spinous processes of the last 
cervical and of the first and second dorsal, rarely also from the sixth 
cervical and from the third dorsal vertebra?. Its fibres are directed 
obliquely downward, and divide most frequently into four and more 
rarely into three digitations, which are attached to the upper edge and 
to the external face of the second, third, fourth, and fifth ribs, a little 
beyond their angle. 

§ 1011. Sometimes a single head leaves the upper part of this 
muscle, ascends along the levator anguli scapulae muscle, and goes 
to the transverse process of the first cervical vertebra.(l) 

B. SEBBATUS POSTICUS INFERIOR. 

§ 1012. The serratus posticus inferior muscle, Lombo-costal, Ch.,is 
broader but thinner than the superior. It arises by a very broad but 
thin tendinous expansion from the spinous processes of the last two 
dorsal and the first three lumbar vertebrae, and adheres to the posterior 
tendon of the latissimus dorsi muscle so intimately that it may be said 
in fact to come from it. Its fibres have the same direction as that of 
the tendon, that is, they descend obliquely from behind and downward, 
and are attached, usually by four digitations, to theinferior edge of the last 
four ribs before their angle, from which they separate still more as they 
are lower, so that the upper in some measure cover the lower. 

Between these two muscles is an elongated, very thin, aponeurotic 
expansion (§ 1009), in the tissue of which we evidently perceive trans- 
verse fibres in one part and another, but especially at its upper and 
lower parts : this expansion arises from the spinous processes of the 
dorsal vertebrae situated between the two muscles, and is attached to 
the angle of the ribs. 

§ 1013. The two muscles form, with the aponeurosis which unites 
them and the bones placed before them, a kind of canal, in which are 
situated the subjacent dorsal muscles, which are compressed and kept 
in place by their simultaneous action. The upper raises the ribs to 
which it is attached. The lower acts with more power, because the 
ribs in which it is inserted are less firmly fixed, and it draws them 
downward and outward. These two muscles assist in inspiration, and 
are not antagonists. 

(1) Rosenmiillcr, loc.cil , p. 5. 



70 DESCRIPTIVE ANATOMY. 



IV. SPLENII MUSCLES. 



§ 1014. The splenii muscles (M. splenii) are considered by many 
anatomists as forming only one muscle, because their two lower ex- 
tremities are so intimately connected. But the proportionally small 
extent of their union makes it more convenient to regard them as two 
separate muscles, one of which however is a repetition of the other : the 
lower is the splenius colli, the upper the splenitis cajyitis. Both are 
situated directly under the trapezius, and go, from below and inward, 
upward, forward, and outward. They are elongated, flat, and thin. 
They occupy the space between the spinous processes of the lower 
and the transverse processes of the upper vertebrae or of the correspond- 
ing bones. 



A. SPLENIUS COLLI. 



§ 1015. The splenius colli muscle, Dorso-trachelien, Ch., arises, by 
short and tendinous fasciculi which are not very deeply separated, from 
the spinous processes of the third, fourth, and fifth dorsal vertebra. It 
is attached by two, rarely by three, other longer digitations to the 
extremities of the transverse processes of the two, rarely of the three, 
upper cervical vertebra?. 



B. SPLENIUS CAPITIS. 



§ 1016. The splenius capitis muscle, Cervico-mastoidien, Ch., is 
broader and stronger than the preceding, and is situated immediately 
above it ; hence its lower edge is attached to the upper edge of the 
other. It arises, by short tendons, from the cervical ligament at the 
side of the spinous processes of the third, fourth, fifth, and sixth cer- 
vical vertebras, rarely also of the second, from the spinous process of the 
last cervical vertebra, and more rarely from those of the upper two 
dorsal vertebras, and is attached to the posterior part of the mastoid 
process in its whole extent, where it covers the sterno-cleido-mastoi- 
deus muscle, and to the external part of the asperity situated below 
the upper curved line of the occipital bone, and consequently to a part 
of the bones of the skull which corresponds to the transverse processes 
of the vertebras. 

§ 1017. The splenius colli muscle turns the neck, and the splenius 
capitis turns the head, so as to carry the face to the opposite side. At 
the same time they incline these parts a little backward ; and when 
they have been turned from the opposite side, they render them straight. 



MYOLOGY. 71 

ARTICLE THIRD. 

MUSCLES OF THE THIRD LAYER. 

§ 1018. The third layer comprises the sacro-spinalis, the cervicalis 
descendens, the biventer cervicis, the complexus, the trachelo-mastoi- 
deus, and the transversalis colli muscles which are attached to the ribs 
and head, and have all an oblong form. 

I. SACRO-SPINALIS. 

§ 1019. The sacro-spinalis muscle, the largest of all these muscles, 
extends almost the whole length of the vertebral column. It falls most 
of the channel between the spinous processes and the transverse pro- 
cesses of the vertebrae and the ribs, and divides into two bellies, which 
are united below to a considerable extent. The external belly is 
called the sacro-lambalis muscle, and the internal the longissimus 
dorsi muscle. 

The common belly, which is considerably thick, arises from the 
upper, inner, and posterior part of the crest of the ilium, from the upper 
oblique and spinous processes of the sacrum, from the posterior 
sacro-iliac ligament, where it unites with the glutaeus maximus mus- 
cle, from the spinous processes of all, or only from the lower four of the 
lumbar vertebrae, and besides from each lumbar vertebra by short digita- 
tions, the external of which is attached to almost all the transverse 
process, and the internal to the accessory process (processus uccessorius) 
of the latter. Its external part is fleshy. The internal is entirely 
tendinous at its lower part, but only on the surface at its upper. The 
tendon is very strong and dense, especially where it comes from the 
spinous processes of the lumbar vertebra?. 

This common belly extends to the twelfth rib, where it divides to 
form the two muscles above mentioned. These gradually become 
thinner as they ascend, and divide into a great many slips. 

The longissimus dorsi muscle is attached, 1st, by twelve bands, 
which grow shorter as they ascend, to the extremities of the transverse 
processes of the dorsal vertebrae ; 2d, farther outward, by seven or 
eight shorter, weaker, closer, broad slips, to the posterior and smooth 
face of the neck<= of the corresponding lower ribs. 

The sacro-lumbalis muscle, the outer belly of the sacro-spinalis mus- 
cle, receives in its course several accessory fasciculi which may be 
considered so many origins. These fasciculi arise by tendinous fibres 
from the angles of the twelve ribs. Their form is oblong, and they 
become longer and thinner the higher they are ; they go a little 
upward and outward. Arising from all these points, the muscle is 
attached by thirteen slips, which gradually diminish in length from 
above downward, 1st, to the inferior edges of the angles of the ten or 



72 DEBCRITTIVE ANATOMT. 

eleven lower ribs, and to the upper edge of the angle- of the first or of 
the two upper ribs, near their tubercles ; 2d, by the thirteenth slip 
which is the uppermost, to the transverse process of the last cervical 

vertebra. ,. . 

The two bellies extend the trunk, prevent it from bending forward, 
incline it backward and a little to the side, and draw the nbs downward. 

II. CERVICALIS DESCENDERS. 

§ 1020. The cervicalis descenders, more properly ascendens muscle, 
is only, strictly speaking, the upper part of the sacro-lumbalis muscle. 
It arises from the angle of the third, fourth, fifth, and sixth ribs, by three 
or four longitudinal slips which correspond to the accessory fasciculi of 
the sacro-lumbalis muscle, and unite in a short, thin belly. This 
usually divides into four, sometimes only three or even two digitations, 
which gradually increase in volume from below upward. 

These digitations are attached to the posterior roots of the transverse 
processes of the third, fourth, fifth and sixth cervical vertebrae. 

It draws the neck backward, and inclines it a little to the side. 
When the neck is fixed, it slightly raises the ribs. 



IIL BIVENTER CEB.VICIS. 



§ 1021. The biventer cervicis muscle* is situated very near the 
median line, and is mostly covered by the splenii muscles, which 
entirely conceal it, except at its upper and lower extremities. It ex- 
tends from the centre of the pectoral portion of the vertebral column 
to the occipital bone. It is an elongated and thin muscle composed of 
two rounded bellies, and of a central tendon nearly as long as the two 
bellies. The upper part of its external edge blends intimately, 
especially by the tendon of the upper belly, with the complexus 
muscle situated at its side. 

The lower belly arises by from two to five fasciculi, the inferior of 
which are the longest and thinnest, from the posterior face of the 
transverse processes of the second, third, fourth, fifth, sixth, seventh, 
and eighth dorsal vertebrae. 

It usually blends with the longissimus dorsi muscle by one of the 
inferior fasciculi, or by a distinct muscular band. Its lower extremity 
is constantly united with the heads of the transversalis colli muscle, 
and most generally with the lower extremity of the trachelo-mas- 
toideus muscle. 

These fasciculi, situated one above another, so that the posterior 
cover the anterior, unite to the inferior belly, which terminates im- 
perceptibly in a point at its summit, and which almost always sends 
along the inferior face of the central tendon, a thin muscular slip 
which extends to the upper belly. 

This central tendon, which, from its situation, is much longer, and 
more apparent on the posterior face of the muscle, the only place, 

* The long- portion of the complexus muscle of most anatomists. 



MYOLOGY. 73 

I 

properly speaking, where it is entirely loose ; commences nearly 
opposite the third dorsal, and extends as high as the fifth cervical 
vertebra. 

The upper rounder belly is stronger and longer than the lower, and 
enlarges at its upper extremity, and is thinner in this part than the 
rest. It becomes a short tendon upward, by which it is attached to 
the inner part of the upper curved line of the occipital bone. 

Sometimes, and even usually, this muscle has three bellies, because 
the upper belly at the point of union with the tendon of the com- 
plexus muscle, is divided into two portions, an upper larger, a lower 
smaller, by a tendon which is often an inch long, and which is like- 
wise seen on its posterior face. 

Usually also we see one of the three fasciculi coming from the 
spinous process of the last cervical, or of the first dorsal vertebra, 
sometimes also from the fifth and the sixth cervical vertebrae, to go to 
the internal edge of the upper belly, a little above its lower extremity. 

This muscle extends the neck, keeps it straight, and brings it back- 
ward. When it acts with its fellow, it extends it backward. 

V. COMPIEXUS. 

§ 1022. The c&mplexus muscle is situated at the side of the pre- 
ceding, and should be regarded as its external portion.(l) It is 
broader and stronger, but shorter than it, and generally extends only 
from the third cervical vertebra to the occipital bone. Its form is an 
oblong and irregular quadrilateral. 

It arises by from six to nine fleshy heads, which are very tendinous 
at their lower part, of which an inferior is deficient more frequently 
than a superior ; these arise from between the third cervical and 
the fifth dorsal vertebras. The three or four lower heads arise from 
the upper and external parts of the transverse processes ; the others 
more internally, from the articular processes ; so that each of the 
latter arises from two successive vertebra. All ascend obliquely, the 
inferior straighter than the others towards the spinous processes and 
the biventer cervicis muscle, and unite in a large fleshy belly, in which 
we can always trace the fasciculi of the heads which form it. 

We perceive a little above the centre of this belly an intermediate 
tendon, more or less perfect, and usually stronger at its internal part ; 
which unites by this part with the second intermediate tendon of the 
biventer cervicis muscle, and which is also more apparent on its ex- 
ternal than on its internal face. 

The complexus muscle is attached by very short tendinous fibres 
which form a broad, single, rounded, and convex edge, to the ex- 
ternal part of the upper curved line of the occipital bone. 

(1) This muscle and the preceding - , are described by Chaussier as the trachdo- 
occipital, F. T. 

Vol. II. 10 



74 DESCRIPTIVE ANATOMY. 

Its uses are the same as those of the preceding muscle, but it draws 
the head more obliquely to its side when it acts alone. 

§ 1023. A thin accessory muscle sometimes arises from the transverse 
process of the second dorsal vertebra, ascends toward the head, and is 
attached to the occipital bone between the complexus and the rectus 
posticus muscles. This formation is remarkable as being analogous 
with the formation of birds. 

V. TBACHELO-MASTOIDEUS. 

§ 1024. The trachelo-mastoideus muscle, Trachelo-mastoidien, Ch. 
(JVf. trachelo-mastoideus, s. mastoideus lateralis, s. complexus parvus), 
is next on the outside of the complexus muscle, is by no means as pow- 
erful, and strictly speaking should not be separated from the trans- 
versalis colli muscle, being in fact its internal and upper part. 

It arises by from one to seven heads, of which a superior is deficient 
more frequently than an inferior. It extends from the third cervical to 
the sixth dorsal vertebra, arising by its lower heads from the upper 
part of the outer extremities of the transverse processes and from the 
oblique processes by its upper heads, and is here intimately united with 
the origin of the biventer cervicis, the complexus and the transversalis 
colh, and most generally at its lower part with the longissimus dorsi 
muscle. These heads unite in a thin muscle, which ascends along the 
anterior edge of the complexus muscle, and its upper extremity is 
attached to the posterior edge and to the lower extremity of the mas- 
toid process of the temporal bone. 

This is the usual arrangement : but sometimes this muscle is divided 
into two bellies by a long intermediate tendon. Sometimes its upper 
part is separated into two and even three slips, the lower of which are 
attached to the transverse processes of the first and even of the second 
cervical vertebra. 

It flexes the neck, which it inclines obliquely to its side, making the 
head lean a little in the same direction. 

VI. THANSVEBSALJS COLLI. 

§ 1025. The transversalis colli muscle is situated on the outside of 
the preceding, and is sometimes closely united with it and sometimes 
separated from it in a very inconstant manner. It extends between the 
first cervical and the middle and even the inferior dorsal vertebrae. 

It arises by five, six, or seven heads from the transverse processes of 
the upper eight dorsal and the lower three cervical vertebras ; so that 
the upper heads are deficient more frequently than the lower. 

Usually it is not situated so high, does not arise so low, and is at- 
tached by four or five upper heads to the extremities of the posterior 
roots of the transverse processes of the first six cervical vertebrae, although 
generally it does not extend to the first. 



MYOLOGY. 75 



Its size, the number of slips of its origin and insertion, are opposite to 
t'oseofthe trachelo-mastoideus muscle in all these respects, if we 
would consider it a muscle distinct from the last. 

It extends the neck and inclines it a little backward. 



ARTICLE FOURTH. 

FOURTH LAYER OF MUSCLES. 

§ 1026. The fourth layer comprises numerous muscles, all of which 
are situated between the vertebrae or between these bones and the head. 
Those between the different vertebrae are the semispinalis cervicis, the 
semispinal dorsi, the spinalis dorsi, the multifidus spinas, the inter- 
spinales, the supraspinal, and the intertransversarii ; those situated 
between the upper vertebrae and the head are the recti muscles, the 
obliqui muscles, and the rectus capitus lateralis muscle. 

I. DORSAL MUSCLES OF THE FOURTH LAYER. 

A. SEMISPINALIS COLLI. 

§ 1027. The semispinalis colli muscle(l) arises by five or six heads, 
the inferior of which are the longest, feeblest, and straightest, from the 
posterior face of the extremities of the transverse processes of the five 
or six upper dorsal vertebrae. It extends obliquely upward and inward 
and is attached bv four separate heads to the lower edge of the tuber- 
cles of the spinous processes of the second, third, fourth, and fifth cer- 
vical vertebra?. 

It extends the neck, and inclines it a little obliquely backward. 

B. SEMISPINALIS DORSI. 

§ 1028. The semispinalis dorsi muscle resembles the preceding in 
form and situation. It arises by six or seven inferior heads from the 
posterior faces of the transverse processes of the fifth, sixth, seventh, 
eighth, ninth, tenth, and eleventh dorsal vertebrae, goes obliquely up- 
ward and inward, and is attached by five or six separate slips to the 
lower edge of the summit of the spinous processes of the lower two 
cervical and the three or four superior dorsal vertebras. 

These two muscles should be considered as one, and their separation 
is purely artificial. (2) When united, they correspond to the complexua 
and to the biventer cervicis muscle. 

(1) This muscle is generally termed the spinalis colli muscle ; but this term should 
be rejected, because then its analogy with the following muscle, of which it is the con- 
tinuation, is neglected. Albinus noticed this fact. (Hist. muse. p. 381.) 

(2) Albinus' remark upon these muscles is generally correct : " With which (the 
spinalis) it is sometimes so blended, that it is doubtful to which the proximate heads 
and extremities belong." (Hist. muse. p. 382.) 



76 DESCRIPTIVE ANATOMY. 

The semispinalis dorsi resembles the preceding in its action on the 
back and lower part of the neck. 



C. SPINALIS DORSI. 



§ 1029. The spinalis muscle, usually called the spinalis dorst muscle, 
can never be presented as a distinct muscle, being always blended with 
the longissimus dorsi, the multifidus spinae situated below, and the 
semispinalis dorsi muscles. It rests directly on the upper and posterior 
parts of the arches of the vertebrae, and arises by four or five separate 
heads from the lateral faces of the spinous processes of the upper two 
lumbar and lower two or three dorsal vertebrae. These heads remain 
for a long time tendinous. The middle belly soon divides into from 
four to eight upper heads, which are attached to the lateral faces of the 
spinous processes of the upper dorsal vertebrae. 

This muscle represents particularly the digitations of the biventer 
cervicis muscles, which are usually attached to one or some of the 
spinous processes of the lower cervical vertebrae. 

It extends the vertebral column and inclines it to its side. 



D. MULTIFIDUS SPINS. 



§ 1030. The mullifidus spina muscle is formed by ft great many 
fleshy bands, which extend obliquely downward from the transverse 
processes to the spinous processes of the vertebras above, and which 
interlace so differently that they thus give rise to a muscle. This muscle 
forms the last layer of the muscles of the back and neck, and fills the 
inner and deepest part of the hollow between the transverse and spinous 
processes. 

The highest slip is attached by its upper extremity to the spinous 
process of the second cervical vertebra, and the lowest slip is inserted 
in the transverse processes of the fourth and fifth vertebrae of the sacrum. 

The muscle becomes considerably thinner as it ascends, and in the 
same proportion less fleshy but more tendinous. The lower its fibres 
the more perpendicular its direction. 

It is united more or less intimately with the spinalis and the semi- 
spinalis dorsi and colli muscles. Taken as a whole with these three 
muscles, it represents for the rest of the vertebral column and for the 
vertebrae the biventer cervicis and the complexus. 

It extends the vertebral column and moves it to one side. 



&, INTERSPINALS. 



§ 1031. The interspinales muscles are short muscles formed of lon- 
gitudinal fibres, which are situated between the summits of the spinous 
processes of two adjacent vertebrae. 

The most apparent are those of the cervical vertebrae. Those of the 
Jumbar vertebrae are the most feeble. Those of the dorsal vertebrae are 



MYOLOGY. 77 

the least distinct and often partially deficient. The cervical, as their 
spinous processes enlarge, become doubled more frequently than in the 
other regions, and thus divide into two separate muscles, a right and a 
left. 

§ 1032. We sometimes find in the neck supraspinaks muscles (JVT. 
interspinahs supemumerarii, s. supraspinaks), which are more super- 
ficial than the preceding and which sometimes pass over several ver- 
tebrae. Thus we sometimes find in the same subject thin and small 
muscles, which pass from the summits of the transverse processes of 
the sixth or seventh to the corresponding parts of the second cervical 
vertebra, and below them other feebler muscles, which go from the 
seventh to the third cervical vertebra : both exist either on one or on 
both sides. These supraspinales muscles are sometimes shorter. 

According to our dissections, the supraspinales muscles exist more 
frequently than they are absent. They evidently correspond to the 
spinalis dorsi muscle (§ 1029) ; so that they would be more properly 
termed the spinales cervicis muscles. They are generally situated on 
the summits of the spinous processes and not on their sides. Their 
presence in the neck is remarkable as an analogy with the rectus 
capitis posticus major muscle, which normally passes over the first cer- 
vical vertebra. 

They are always looser and more detached than the fleshy slips 
which compose the spinalis colli muscle, in which they resemble the 
type of the other muscles of the neck and of the cervical vertebras. 

They extend the vertebral column. 

P. INTEBTHAKSVEB8ARn. 

§ 1033. The intertransversarii muscles are formed of longitudinal 
fibres and are situated between the transverse processes of two vertebrae. 
In the cervical region they are double, like the interspinals muscles, 
and are called the anterior and posterior : the former extend between 
the anterior roots and the latter between the posterior roots of two 
transverse processes. 

They incline the vertebral column to the side. 

II. MTJSCI.ES OP THE FOURTH LAYER BELONGING TO THE HEAD. 

§ 1034. The muscles of the fourth layer belonging to the head per- 
fectly resemble in their essential characters those muscles of the same 
layer which belong to the back or those of the layers over them, and 
are more largely developed only from the weight which they are obliged 
to move. They are imbedded in loose cellular tissue, which separates 
them from each other and from the muscles below. 

They are the two straight, two oblique, and one lateral muscle. 



78 DESCRIPTIVE ANATOMY 



A. POSTERIOR RECTI MUSCLES OP THE HEAD. 

§ 1035. The two recti muscles of the head (M. capitis recti) corre- 
spond to the imerspinales muscles, and are in fact the two superior. 
The transition from them to the latter is marked by the imerspinales 
colli muscles, which are strongest and in pairs, and also by the supra- 
spinal muscles, (§ 1032), which are often seen. 

a. Rectus capitis posticus major. 

§ 1036. The rectus capitis posticus major muscle, Jlxoido-occipital, 
Ch., (M. capitis posterior rectus major, s. superficialis, s. epistrophico- 
occipitalis), is triangular and arises from the upper face of the spinous 
process of the second cervical vertebra. It begins below in a point, 
enlarges very much at its upper part, passes above the arch of the 
atlas and over the rectus capitis posticus minor muscle, and is attached 
by a thin and rounded edge to the lower curved line of the occipital 
bo.v?. 

§ 1037. This muscle not unfrequently occurs double, and this excess 
is analogous to the normal formation in the ruminating animals and 
in birds. 

It extends the head directly backward. < 

b. Rectus capitis posticus minor. 

§ 1038. The rectus capitis posticus minor muscle, Jltloido-occipital, 
Ch., (JVf. posticus capitis minor, s. profundus, s. atlanto-occipitalis), 
arises from the spinous process of the first cervical vertebra and is at- 
tached to the internal part of the lower curved line and also to the rough 
surface below, between it and the posterior edge of the large occipital 
foramen. It is triangular like the former, but much broader in propor- 
tion to its length. Its summit is likewise turned downward. 

This muscle acts like the preceding, but is less powerful, from its 
smallness and its unfavorable insertion. 

These two muscles represent the upper two spinales colli muscles. 
The rectus major muscle corresponds to the second, which from the 
great weight it moves passes by the first vertebra and is attached to 
the corresponding part of the occipital bone. The rectus minor corre- 
sponds to the first ; it is not an exception to the rule. 

B. OBLIQUE MUSCLES OF THE HEAD. 

a. Obliquus capitis inferior. 

§ 1039. The obliquus capitis inferior muscle, Axoido-atloidien, Ch., 
ia the strongest of the small muscles of the head and has an oblong 



MTOLOGT. 79 

quadrilateral form. It arises below and on the outside of the rectus 
capitis major muscle (§ 1035), from the lateral face of the spinous 
process of the second cervical vertebra, goes obliquely upward, outward, 
and forward, and is attached to the posterior face of the extremity of 
the transverse process of the first cervical vertebra. 

It moves the neck and at the same time the head, which it rotates 
on their axes ; so that the face is turned toward the side of the muscle 
which contracts. 

This muscle seems to be the external part of the second spinalis 
colli muscle largely developed, the upper extremity of which would 
proceed to the next vertebra, as do all the other spinales muscles, but 
it goes more externally on account of the turning of the head. Farther, 
we may compare it to the splenii muscles of the preceding layer, for it 
resembles them perfectly in its insertions, direction, and uses. 

b. Obliquus capitis superior. 

§ 1040. The obliquus capitis superior muscle, Atloido-sous-mastoi- 
dien, Ch., is triangular. It arises above the preceding, from the upper 
face of the summit of the transverse process of the first cervical verte- 
bra. It goes obliquely upward and inward, enlarges, and is attached 
to the occipital bone on the external part of the rough surface in the 
space between the two ridges. 

It draws the head backward and a little to the side, so as to bring 
it near the occiput and turn the face from the opposite side ; hence it is 
the antagonist of the preceding muscle. 

We may consider it as a part of the upper intertransversarius cer- 
vicis muscle or as the upper and posterior part of the second interspi- 
nalis muscle, and consequently as the upper part of the preceding. This 
similarity however is still greater if we compare it to the upper slip of 
the multifidus spinae muscle, the deficiency of which as stated by most 
anatomists will be compensated for in this manner. 

C. RECTUS CAPITIS LATERALIS. 

§ 1041. The rectus capitis lateralis muscle, Atloido-sous-occipital^ 
Ch., is the smallest in this region, and arises from the upper part of the 
transverse process of the first cervical vertebra, goes forward and out- 
ward, and is atttached to an impression in the occipital bone behind the 
posterior edge of the foramen lacerum. 

It draws the head to the side and a little forward. 

It evidently wholly or partially represents the posterior intertransver- 
sarius cervicis muscle, which is here larger and goes a little farther 
forward. 

This muscle is sometimes double, an arrangement normally seen in 
birds. 



80 DESCRIPTIVE ANATOMY. 

ARTICLE FIFTH. 

ACCESSORY MUSCLES OF THE FOURTH LAYER. 

§ 1042. We may also for the convenience of study refer to this 
fourth layer of the dorsal muscles the levatores costarum, the scaleni, 
the quadratus lumborum, and the intercostales muscles, and oppose 
them to the preceding as being accessory muscles, from the analogy of 
the bones of the trunk. 

I. LEVATORES COSTARUM. (1) 

A. LEVATORES COSTABUM BEEVES, 

§ 1643. Each rib has a short levator muscle. These muscles (leva- 
tores costarum breves) are triangular : they arise from the inferior edge 
of the summit of the transverse process of the next superior dorsal 
vertebra, go obliquely downward and outward, gradually enlarge in 
their course, and are attached to the posterior and superior edge of the 
portion of the ribs comprised between the tubercle and the angle, but 
they do not extend to the latter. 

They are mostly tendinous on their posterior face. 

B. LEVATORES COSTARUM LONGI. 

§ 1044. Besides, the three to five inferior ribs have long levators 
(levatores costarum longfywhich are also triangular,but broader, situated 
more externally, and more superficially than the short. They arise near 
the summit of the transverse processes of the inferior dorsal vertebrae 
and pass over one rib to be attached to the following. 

The long and short levators of the ribs are uninterruptedly con- 
tinuous with the external intercostal muscles. 

The action of these muscles is indicated by their name. 

II. SCALENI. 

§ 1045. The scaleni should be called the long levators of the upper 
ribs, for they resemble the preceding in situation and form, although 
they act less on the ribs than upon the cervical vertebrae. 

Their general characters are : 1st, they are oblong, triangular, and 
pointed at their two extremities ; 2d, they arise from the upper edge and 
from the external face of one or both of the two upper sides by a single 

(1) The levatores breves and Iongi are sometimes termed Collectively the supra- 
costalee muscles. J r 



MYOLOGY. 81 

broad tendon ; 3d, they are attached to the transverse processes of seve- 
ral cervical vertebrae by different tendinous bands; 4th, they flex the neck 
to the side and raise the ribs. Their number is not always the same, 
and varies from three to six. The most constant and the largest are 
three in number ; the anterior, the lateral or middle, and the posterior. 

A. SCALENUS ANTICUS, 

§ 1046. The scalenus anticus muscle, Costo-lrachelien, Ch., is situ- 
ated behind and below the stemo-cleido-mastoideus muscle. It arises 
from the upper face of the first rib, some distance behind its anterior ex- 
tremity, goes upward and backward, and terminates in two, three, or 
four bellies, which are usually separated only at their upper part, and 
are attached to the anterior tubercles of the transverse processes of the 
third, fourth, fifth, and sixth cervical vertebrae. 

B. SCALENUS MEDIUS. 

§ 1047. The scalenus medius muscle, the longest of all, arises from 
the first and second ribs, about an inch farther backward and outward 
than the preceding, goes directly from below upward, and is attached 
most generally by seven slips to the posterior tubercles of the transverse 
processes of the seven cervical vertebrae. 

C. SCALENUS POSTICUS. 

§ 1048. The scalenus posticus muscle, the shortest of all, arises much 
farther back than the others, from the posterior part of the external face 
of the second rib, goes obliquely upward and forward, and is attached, 
behind the two preceding by two and rarely by three long and tendinous 
slips, to the posterioi extremities of the transverse processes of the fourth, 
fifth, and sixth cervical vertebrae It is sometimes deficient. 

D. SUPERNUMERARY SCALENI MUSCLES. 

§ 1049. The unusual or supernumerary scaleni muscles are usually 
developed between those already described and are smaller than them. 
An anterior, which is situated between the scalenus anticus and me- 
dius, and is sometimes called the Scalenus minimus, Albinus, is some- 
times formed by the division of the anticus, since it is situated directly 
behind it and comas from the first rib. It is attached by one, two, or 
three heads to the anterior extremity of the transverse processes of the 
fifth, sixth, and seventh cervical vertebras. Usually, the inferior nerves 
of the brachial plexus and the axillary vessels pass along its posterior 
face, between it and the scalenus medius, and the upper nerves along 
its anterior face, between it and the scalenus anticus muscle, although 
when this muscle is deficient they all pnss between the scalenus anti- 
cus and medius. 

Vol II 11 



5»2 DESCRIPTIVE, ANA T0M1 

This supernumerary scalenus anticus muscle often forms a more- 
distinct muscle, being still more remote from the anticus and arising 
farther behind the upper face of the first rib. It is then always shorter, 
and is attached only to the summit of the transverse process of the sixth 
cervical vertebra, or of this and the fifth. 

We have sometimes found it double. In this case there is an exter- 
nal and an internal, the former situated behind and the second before 
the last two nerves of the brachial plexus. The external or posterior 
is attached by a double upper slip to the anterior and posterior tubercle 
of the transverse process of the sixth cervical vertebra ; and the inter- 
nal or anterior is inserted by four slips placed above each other only in 
the anterior tubercles of the transverse processes of the fifth and sixth 
cervical vertebra?. 

The supernumerary scalenus lateralis or posticus muscle is situated 
between the scalenus medius and the scalenus posticus. It arises from 
the posterior part of the first rib and is attached between the slips of 
these muscles to the summits of the transverse processes of the fourth, 
fifth, and sixth cervical vertebrae. 

We have sometimes found these three supernumerary scaleni at once 
in the same subject. 

§ 1050. It is more unusual to find an analogous muscle coming from 
the transverse process of the sixth cervical vertebra and inserting itself 
into the inferior face of the humeral extremity of the clavicle.(l) 

III. QUADRATUS LUMBORIM. 

§ 1051. The quadratics lumhorum muscle, Ilio-costal, Ch., is an ob- 
long and rounded muscle, situated at the side of the lumbar vertebra?, 
between the posterior portion of the crest of the ilium and the twelfth 
rib, so that it forms in part the posterior wall of the abdomen. 

It is composed of two more or less evident layers* an anterior and a 
posterior. The posterior layer is the most extensive. It arises from 
the inner lip of the iliac crest, a little behind its centre, and from 
the ilio-lumbar ligament by a broad tendon ; becomes larger after aris- 
ing, inclines inward toward the vertebral column, divides into five or six 
heads which are attached to the inferior portion of the extremities of 
the transverse processes of the three or four upper lumbar vertebra? and 
to the lateral portion of the bodies of the two inferior dorsal vertebra?, 
and is finally inserted by a broad slip in the inner part of the inferior 
edge of the twelfth rib. 

The anterior layer is thinner, and arises by some tendinous slips 
from the upper part of the extremities of the transverse processes of 
the three or four inferior lumbar vertebrae., and blends with the pre- 
ceding. 

(l)Kekb, Beijtrcc^c zur pathologte/hcn anatomic, p. 32, No. xxxiv 



MYOLOGY £3 

The quadratus lumborum muscle evidently represents the levatores 
costavum, the scaleni, the levator anguli scapulse, and the rhomboidei 
muscles ; and anteriorly, the pyramidal muscles. We must not com- 
pare this muscle, but the two obliqui abdominis muscles, to the inter- 
costales muscles. The two layers of which it is composed, fully justify 
the parallel drawn between it and the preceding muscles. 

It flexes the lumbar vertebra? to its side, and depresses the lower 
ribs. 

IV. INTERCOSTALES. 

§ 1052. The intercostales muscles are divided into the proper inter- 
costales, and the subclavius muscles. 

I. TROPER INTERCOSTALES. 

§ 1053. Each intercostal space is filled on each side by two thin 
muscular layers formed of oblique fibres, which are called the inter- 
costales muscles. The whole number of these muscles is consequently 
forty-four, of which eleven on each side are external, and eleven internal. 

a. Intercostalc3 Externi. 

§ 1054. The intercostales externi muscles, go from the lower part of 
the external face of the ribs, obliquely from behind forward, to the 
upper part of the outer face of the next rib below, so that their posterior 
fibres are more oblique than their anterior. They commence near the 
tubercle of the ribs, and extend to the costal cartilages. At their ter- 
. mination, they are replaced by an aponeurosis formed of fibres which 
have the same direction. Many tendinous fibres leave their upper 
and lower edges, and are expanded on their external face, which 
extend almost to the opposite edge. 

b. Intercostales Interni. 

\j> 1055. The intercostales interni muscles occupy all the space 
between the costal cartilages and the bony parts of the ribs to their 
angle. Their fibres are oblique from within outward, and from before 
backward, and extend from the internal margin of the inferior edge of 
each rib to the internal lip of the upper edge of the rib directly below. 

The inferior, at their posterior part, occasionally give off slips which 
pass to the next rib, and even to the one below. 

The central are divided by slips, situated between each pair of costal 
cartilages, into two portions ; an anterior, which is smaller, and a 
posterior, which is larger. 

They differ from the intercostales externi muscles because they 
extend farther forward, and not so far backward ; because they are not 
so broad, and because their fibres, which follow a contrary direction 
are straisrhter 



84 DESCRIPTIVE ANATOMY. 

The two layers of intercostal muscles approximate the ribs to each 
other, and usually raise the lower ribs which are more movable, to the 
superior, which are less so. 

§ 1056. We also remark on the internal face of the cavity of the 
thorax, muscular fasciculi, which are not constant, have no fixed place, 
vary much in size, sometimes lean to one side, and may be called the 
infracostahs muscles. Kelch has described them as the internal 
serrati muscles.(l) 

II. SUBCLAVIUS. 

§ 1057. The subclavius muscle, Coslo-claviculaire, Ch., resembles 
the intercostales, especially the externi, in situation and uses. 

It arises by fleshy fibres, which descend obliquely downward and 
outward from the greater external part of- the inferior face of the 
clavicle, and from the outer part of the anterior face of the rhomboid 
ligament ; and it is attached by a strong tendon, which extends along 
its inferior edge to the anterior face of the cartilage of the first rib, not 
far from its anterior extremity. 

It brings the clavicle towards the first rib, which it most generally 
draws downward ; but it can also act in an opposite direction, and 
approximate the rib to the clavicle. 

§ 1058. The analogy between the subclavius and the intercostales 
muscles, is sometimes rendered more evident by the presence of a 
second subclavius muscle, which arises from the coracoid or the 
acromion process, and is attached to the first rib. (2) This anomaly 
indicates the relation between the subclavius and the pectoralis minor 
muscles, and connects the normal state with that in which we find a 
third accessory muscle. 



CHAPTER II. 

ANTERIOR MUSCLES OF THE TRUNK. 

§ 1059. The anterior muscles of the trunk comprise the muscles of 
the abdomen and chest, the anterior muscles of the neck, and the 
muscles of the sacrum and coccyx, when they exist. 



(1) Bcitr. zur Path. Anat., p. 41, No. 32. 

(2) Rohmer, Obs, Anat, part 1. p. 4.— -Rosenmuller, inlsenflamm and Rosenmiil- 
ler, Beit., vol. i., p. 375, and De nonnullis muse. corp. humani varietaiibvs, p. 6. 



MYOLOGY. 
ARTICLE FIRST. 

OF THE ABDOMINAL MUSCLES. 

§ 1060. We find in the abdominal region seven pairs of muscles 
which form its parietes; four are broad, two are long - , and one is short. 

§ 1061. The four broad muscles are the obliquus externus, the 
obliquus internus, the transversalis, and the diaphragm. The two 
long muscles are the rectus abdominis and the pyramidalis. The 
short muscle is the quadratus lumborum (§ 1051). This latter has 
already been described. 

Among the broad muscles, the first three are situated before and on 
the sides of the abdominal cavity, while the diaphragm occupies the 
upper and posterior part : the two long muscles belong to the anterior 
wall, and are situated on the median line. 

I. 03LIQUUS EXTERNUS ABDOMINIS. 

§ 1062. The obliquus abdominis externus or descendens muscle, 
Costo-abdominal, Ch., is situated directly under the skin. It covers 
not only the other two broad abdominal muscles, but also the anterior 
part of the inferior intercostales and the last eight ribs, on the anterior 
face of which it is placed. 

Its posterior part is fleshy, and its fibres go obliquely downward, in- 
ward, and forward. " It arises from the last eight ribs by eight slips, 
the extremities of which are tendinous, and which are blended with the 
pectoralis major, the serratus major, and the latissimns dorsi muscles. 

Of the eight slips which form the external edge of this muscle the 
upper is the thinnest, but the longest. It is united by the lower part 
of its anterior edge with the inferior part of the pectoralis major muscle, 
while the upper part of this same edge proceeds directly at the side of 
the lower part of the posterior edge of this muscle, and is attached to 
the external face of the fifth rib, about two inches behind its anterior 
extremity. 

The second and third slips are the broadest. The fourth, fifth, 
and sixth gradually become narrower ; the seventh and eighth are 
much narrower than the others, with the exception of the first. 

The eighth is attached not only to the cartilage of the last false rib, 
but also, by its lower part, to the common tendon of the two succeeding 
abdominal muscles. The whole posterior edge is oblique downward 
and backward, from the first slip to the last ; in the rest of its extent, 
which is less, it follows an inverse direction, and goes obliquely down- 
ward and forward. 

The four upper slips are so blended with the four lower slips of the 
serratus magnus muscle, and the four lower with those of the latissi- 



86 DESCRIPTIVE ANATOMY. 

mus dorai muscle, that all these slips intercross with each other by 
tendinous edges, directed obliquely upward and inward. 

The substance of the muscle becomes much thicker from above 

downward. 

The inferior edge of the fleshy portion is attached by short tendinous 
fibres to the anterior half of the internal lip of the iliac crest. It ter- 
minates at the anterior and superior iliac spine. The anterior edge 
describes, inward and for* aid, two convexities, a superior which is 
shorter, and a posterior which is much larger, which are separated by 
an intermediate depression. It is continuous with the broad anterior 
tendon. 

The fleshy part of the obliquus externus abdominis muscle repre- 
sents an oblong rhomboid, the centre of which is the broadest portion 
and the upper part the narrowest. 

The tendon of this muscle is as broad, but much higher than its 
fleshy portion, since it extends from the inferior edge of the pectoralis 
major muscle and the cartilage of the sixth rib to the symphysis pubis. 

Its upper part is the weakest and thinnest, and it terminates upward 
in a straight edge, which corresponds to the median line ; backward 
by another edge which is channeled in two places, a superior and an 
inferior. The anterior edge of its fleshy portion is attached to the 
latter. Its inferior edge is oblique from above downward. The supe- 
rior is much shorter than the others and is attached to the anterior 
face of the cartilage of the sixth rib, and blends with the tendinous 
fibres of the pectoralis major muscle. 

The internal is so intimately united with the same muscle of the 
other side that the fibres of both muscles extend" in their whole extent 
a. little beyond the median fine. 

The inferior is loose, and extends from the upper and anterior spine 
of the ilium to the symphysis pubis ; its direction is consequently 
oblique from above downward and forward. It forms a kind of bridge, 
which is extended over the space which exists in this place between 
the crest of the ilium and the horizontal portion of the pubis. This 
inferior edge is very improperly called the ligament of Fallopius {Lig. 
Fallopii, s. Powparti) ; it is more properly termed the crural arch 
(arcus cruralis). 

Although the lower edge of the tendon of the obliquus externus 
abdominis muscle leaves the bones when it reaches the anterior and 
superior spine of the ilium, still it unites intimately an inch and a half 
farther, below and inward, with the outer part of the anterior face of 
the crural aponeurosis, and of the tendon of the fascia-lata muscle, 
which fixes it so firmly that the origin of the crural aponeurosis cannot 
be displaced except at the place where this union ceases. From its 
point of union with the aponeurosis of the thigh, fibres ascend, of which 
the internal particularly are very strong, and go to the anterior face of 
the tendon. 



MYOLOGY 87 

The crural arch is the thickest and strongest part of the tendon of 
the obliquus extern us muscle. In its course, it turns slightly upward 
and inward, thus forming a channel or semicanal, in the anterior part 
of which the spermatic cord descends. 

This semicanal commences about an inch on the outside of the 
external angle of the inguinal ring which we are about to de- 
scribe. It is changed on the inside by the lower part of the obliquus 
interims and transversalis muscles into a canal, which descends 
obliquely, and may be called the inguinal canal (canalis inguinalis) . 
This canal commences at the place where the spermatic cord in the 
male, and the round ligament of the uterus in the female, leave the 
abdominal cavity through the superior, posterior, or abdominal opening 
{apertura canalis inguinalis superior, posterior, s. abdominalis), and 
terminates by another inferior, anterior, or external opening (apertura 
canalis inguinalis inferior, anterior, externa), called also the inguinal 
or abdominal ring (annidus abdominalis). 

From the posterior wall of the crural arch a thin layer arises, which 
is often formed by tendinous fibres, and is frequently simply cellular, 
called the transverse band {fascia transversalis). (1 ) This band extends 
between the external face of the transversalis muscle and the external 
face of the peritoneum. It strengthens, sustains, and limits the upper 
opening of the inguinal canal. 

The connection between the aponeurosis of the thigh and the crural 
arch can be observed in no other place except the point above men- 
tioned, and we may always demonstrate the loose and smooth edge 
which terminates it. Still a tendinous band, some lines broad, not 
unfrequently separates from the inferior edge of the tendon, being 
attached to it only by a condensed cellular tissue, and proceeds below 
and a little behind it, but in a parallel direction, and extends from the 
internal part of the upper extremity of the tendon of the tensor fasciee- 
latae muscle to the pubis, where it is attached to the internal part of the 
posterior face of its horizontal branch. 

This band causes, to a certain extent, the crural arch to appear 
double, or it may be regarded as a special ligament which contracts 
the opening over it. 

Below the crural arch the crural nerves and vessels pass out of the 
cavity of the abdomen to go upon the thigh, and are attached to it 
only by a very loose cellular tissue. The abdominal viscera follow the 
same route in crural hernia. 

The tendon of the obliquus abdominis externus muscle is formed 
principally of fibres which descend obliquely inward. We however 
see on the whole of its anterior face other more feeble and less adherent 
fibres, which go in a contrary direction upward and inward, cross the 
preceding, and serve to increase the solidity of the tendon. 

(1) Cooper in Munro, Morbid Anatomy of the human gullet, &c, p. 422.— See also 
J. Cloqnct, Recherchcs Anatomiques sur les hernies de P abdomen, Paris, 1817-1819. 



88 DESCRIPTIVE ANATOMY 

This tendon presents at its internal part a dozen rounded foramina, 
situated one above another, and forming two series which are not 
arranged in pairs, but on the contrary alternate regularly. These 
openings are for the passage of the cutaneous vessels and nerves. 

The lower part of this tendon presents a broader and more important 
foramen. This foramen is called the inguinal or abdominal ring (an- 
nulus abdominalis). It is an oblong and rounded opening, about an 
inch and a half long end an inch broad, the direction of which is ob- 
lique downward and inward, which is formed by the separation of the 
fibres of the tendon. 

The opening in this place is only a greater development of the pecu- 
liar arrangement of the tendon of the obliquus externus muscle. In 
fact, when we examine this last attentively, we perceive that from the 
external and concave edge of the inguinal ring to the posterior edge 
of the tendon, and in a direction corresponding to that of the ring, thin 
fibres unite in fasciculi separated from each other, so that here and 
there the tendon is formed of weak external fibres, through which 
the color of the subjacent muscles may be seen. The two fibrous fas- 
ciculi are called pillars ; they immediately surround the inguinal ring, 
and the upper is generally in part separated from the rest of the tendon 
by two very considerable foramina, through which nerves and vessels 
pass. They are distinguished into the upper or internal and the 
lower or external pillar (crura annuli abdominalis superius, s. internum, 
ct inferius, s. externum). These are the thickest and strongest parts oi 
the tendon. The lower pillar is stronger than the upper. 

The upper pillar is broader and flatter than the lower and inter- 
crosses with that of the opposite side, so that, the left usually covering 
most of the right, each is attached to the spine of the pubis of the oppo- 
site side, and is blended more or less intimately in this place with the 
fibres of the lower pillar of the other side. 

The lower pillar is shorter and more rounded than the upper, and 
forms the true termination of the lower edge of the fallopian tendon or 
ligament. It is slightly concave at its upper part, and forms a semi- 
canal, which receives the lower part of the spermatic cord. It is 
attached for nine or ten lines by an edge, which is oblique from without 
inward and from behind forward, to the inner part of the horizontal 
branch of the pubis, as faras its spine. 

The spermatic cord passes through the inguinal ring, following the 
direction of the greatest diameter of this foramen, and fills its lower 
portion. Many ascending fibres of the external layer, which arc 
weaker and adhere less firmly to each other, go upon its anterior part. 

The external portion of the tendon of the obliquus externus muscle 
is loose and united with that of the obliquus internus muscle, which 
lies below it, only by a looser mucous tissue. The outer half of this 
part corresponds to the anterior region of the fleshy portion, and the 
inner part to the posterior edge of the tendinous portion of the obliquu? 
internus muscle. 



MYOLOGY. 89 

The smaller internal portion of the tendon unites very firmly with 
the tendon of the obliquus interims muscle, and forms with it the ante- 
rior layer of the sheath of the rectus abdominis muscle. This muscle 
is the most superficial and the largest of all the abdominal muscles 
which it covers almost entirely, except a small posterior and inferior 
part of the obliquus interims and trans versalis muscles. It corresponds 
so much to the intercostales externi muscles in its position, in the direc- 
tion of its fibres, and the slight distance to which its fleshy portion ex- 
tends forward, that we are authorized to say that it represents them in 
the abdomen. 

It draws the ribs downward, contracts the abdominal cavity in 
every direction, and in this manner it assists the other muscles in 
expelling the foreign bodies contained in it. At the same time, as the 
abdominal viscera acted upon by it tend to escape in every direction, 
it contributes immediately to compress the chest from below upward, 
and hence is a muscle of expiration. It assists a little to flex the ver- 
tebral column forward. 

§ 1062. This muscle presents sexual differences in the form of the 
inguinal ring. In fact, in the male, where the large spermatic cord 
passes through it, the ring is broader and rounder than in the female, 
where it gives passage only to the thin round ligament of the uterus. 

§ 1063. Besides the absence of a greater or less portion of its middle 
and anterior part, a defect of formation which is common to it with the 
other muscles of the abdomen in the fissure of the abdomen, the ob- 
liquus externus muscle is subject also to another anomaly, viz. the 
lower part of its anterior tendon is very imperfectly developed, is feeble, 
and presents numerous foramina. This anomaly depends on the 
absence of the external fibres which tie down and retain those of the 
deep layer. It results in a variety of external inguinal hernia, which 
resembles crural hernia because the viscera do not escape through the 
ring, but much more outward. (1) 

II. OBLIQUUS INTEnNUS ABDOMINIS. 

§ 1064. The obliquus internus abdominis muscle, Ilic abdominal, Ch. 
(JVf. abdominis obliquus internus, s. obliquus ascendens), is situated di- 
rectly under fhe preceding, and forms the middle of the three broad mus- 
cles of the abdomen. It is much smaller than the obliquus externus mus- 
cle, and occupies the space between the lower edges of the cartilages 
of the last five ribs, the crest of the ilium, the pubis, and the median 
line. 

The direction of its fibres is directly opposite to that of the fibres of 
the obliquus externus muscle, for they proceed inward, forward, and 
upward. The posterior however are straight, the central very oblique, 
the internal, anterior, and inferior longitudinal, and the lowest of all 

(1) Burns, in Monro, Morbid anatomy of the human gullet, &c, Edinburgh, 1811, 
p. 467. 

Vol. II. 12 



90 DESCRIPTIVE ANATOMY. 

oblique and descending downward and inward. Considered as a whole, 
it is then formed of fibres which are separated from each other like a 
fan. 

The fleshy part of this muscle arises, by its upper edge, by short 
tendinous fibres from the whole inferior edge of the cartilage of the 
tenth and from the anterior part of those of the eleventh and twelfth 
ribs. 

Its posterior edge unites with the posterior aponeurosis of the trans- 
versalis abdominis muscle, and with the common aponeurosis of the 
latissimus dorsi and of the serratus inferior posticus muscles, which 
aponeurosis arises from the spinous processes of the lumbar and sacral 
vertebrae. 

It extends forward and downward much farther than the fleshy part 
of the obliquus externus muscle, and passes as far below it as the latter 
rises above it. 

Its anterior edge is convex above, concave below ; it extends from 
the summit of the cartilage of the tenth rib to near the symphysis 
pubis, terminates about half an inch above this articulation, and its 
direction is generally oblique downward and inward. 

The inferior edge arises from the central face of the larger anterior 
part of the crest of the ilium, and below its anterior and superior spine, 
from the larger external part of the internal face of the crural arch. Its 
inferior fasciculi go very obliquely downward, pass out through the 
inguinal ring with the spermatic cord, which they surround externally, 
and descend with it into the scrotum : they form the cremaster muscle. 

The tendon of the obliquus internus muscle is less extensive than 
that of the obliquus externus muscle ; but from its origin it divides in 
the centre into two layers, an anterior and external, and a posterior 
and internal. The anterior layer is intimately blended with the tendon 
of the obliquus externus muscle (§ 1061), and forms the anterior wall 
of the sheath of the rectus abdominis muscle. The posterior layer 
unites in the same manner with the tendon of the transversalis muscle, 
and forms the posterior wall of the same sheath. 

At its two extremities, on the contrary, the tendon is single, and 
formed only by the anterior layer which passes before the rectus 
muscle, and unites less intimately with the tendon of the obliquus 
externus muscle, especially below. 

_ The upper edge of the tendon begins at the cartilage of the ninth 
rib ; but the posterior layer disappears in the space between the 
seventh and eighth ribs. After leaving this point, the rectus muscle 
is situated directly on the tendon of the transversalis muscle, and 
higher on the costal cartilages. 

The posterior layer of this tendon terminates downward, in the centre 
of the space between the umbilicus and symphysis pubis, by a semicir- 
cular edge, concave below, where its fibres separate a little from each 
other, and finally disappear. 



MYOLOGY. 91 



The obliquus intemus muscle corresponds to the intercostales interni 
muscles (§ 1045), 1st, by the direction of its fibres ; 2d, by its situa- 
tion below the obliquus abdominis externus muscle ; and 3d, because 
its fleshy fibres extend farther forward than those of the latter. 

Like the preceding-, it contracts the abdominal cavity in every direc- 
tion, so that its effects are the same. 



III. TBANSVEHSALIS. 



§ 1065. The transver satis muscle, Lombo-abdominal, Ch., (M. 
abdominis transversus s. interims) much resembles the obliquus inter- 
nus muscle in its extent and direction. Its fleshy part is however 
longer and narrower. The fibres which form it have a transverse 
direction ; the direction of the lower fibres however is a little oblique 
from above downward and from behind forward. 

The external edge is convex outward, and is oblique from above 
downward and from within outward. Most of it arises, by seven 
broad fasciculi which generally are not very distinct, from the internal 
face of the cartilages of the seven lower ribs, and is here blended with 
the anterior edge of the costal portion of the diaphragm. 

The smaller and the inferior part of the posterior edge goes directly 
downward, and is attached to the anterior edge of the posterior tendon 
to be described directly, which comes from the lumbar vertebrae 

The inferior edge is attached to the internal lip of the large anterior 
part of the crest of the ilium, and gradually unites, from the anterior 
and upper spine of the iliac bone to near the inguinal ring, with the 
inferior edge of the obliquus internus muscle ; so that it also gives fibres 
to the cremaster muscle. 

The anterior edge is very concave, especially directly below its 
centre. Its upper part is attached by short fibres to the lateral edge of 
the xiphoid cartilage, but in almost all its length it is attached to the 
anterior tendon. This latter is a little broader at its centre than that 
of the obliquus internus muscle ; but it is much narrower above, 
because of the greater breadth of its fleshy portion. 

It is composed almost wholly of transverse fibres, and forms the 
posterior layer of the sheath of the rectus muscle. This sheath does 
not extend the whole length of the muscle : it does not ascend to the same 
height, and is deficient on the costal cartilages which the recti muscles 
cover ; it frequently terminates also downward, a little above the centre 
of the space between the umbilicus and the pubis ; but we generally 
find in this place a very thin tendinous expansion, to which the lower 
part of the anterior edge of the transversalis abdominis muscle is 
attached, and which sometimes passes behind the rectus muscle, to 
unite beyond its internal edge to the anterior layer of the sheath, and 
sometimes, especially at its inferior part, unites at its external edgo 
principally with that of its lower tendon. 



92 DESCRIPTIVE ANATOMY. 

Besides this anterior tendon, the transversalis muscle has a posterior. 

This is attached by a straight edge to the posterior edge of the fleshy 
portion of the muscle, and divides into two layers; an anterior and a 
posterior. 

The posterior layer is stronger ; it is composed of transverse fibres, 
and is attached by separate slips to the summits of the transverse pro- 
cesses of the upper four lumbar vertebrae and to the lower edge of 
the twelfth rib. Near its insertion, the fibres converge from above and 
below, and unite in a point. This layer is situated between the com- 
mon belly of the longissimus dorsi and quadratus lumborum muscles. 

The anterior layer is much thinner, passes before the quadratus 
lumborum muscle, and is attached by its posterior edge to the roots of 
the transverse processes of the lumbar vertebra. 

The transversalis abdominis muscle corresponds to the triangularis 
sterni muscle in the direction of its fibres, in its situation, in the attach- 
ments of its external edge to the inner faces of the ribs, and by the 
insertion of its inner edge in the sternum and linea alba. 

It acts like the preceding, but serves especially to contract the 
cavity of the abdomen in a transverse direction. 

IV. LINEA ALBA. 

§ 1066. The linea albais a very firm tendinous band, which extends 
along the median line of the anterior wall of the abdomen. It is formed, 
by the union and crossing of the anterior tendons of the three broad 
abdominal muscles, within the sheath of the rectus abdominis muscle. 
Its greatest breadth, which is nearly half an inch, corresponds to the 
region of the umbilicus. From the umbilicus to the pubis, it narrows 
very rapidly ; but it is thers much thicker than at its upper part, where 
it is, on the contrary, much broader. Above, for nearly two thirds of 
the space between the umbilicus and xyphoid cartilage, it is from two 
to four lines broad ; but below the umbilicus it is a line or two less. 

In place of the umbilicus, in the early periods of life, we find an open- 
ing, called the umbilical ring (annulus umbilical is), through which the 
umbilical vessels and cord pass ; but shortly after birth the opening 
closely unites with the remains of these same, so that here the linea 
alba has the most firmness. 

The tendinous part of the anterior wall of the abdomen is here the 
firmest and strongest. 

The linea alba is to the abdomen what the sternum is to the chest, 
except that it is not formed of bones. The anterior tendons of the 
broad muscles are attached to it, as the cartilages of the ribs articulate 
with the sternum ; and the difference of tissue between it and the ster- 
num depends on the general difference of structure between the tho- 
racic and abdominal cavities, the former being almost wholly formed of 
bones, while theparietes of the latter are fleshy and tendinous. 



MYOLOGY. 93 

Finally, we find in the crocodile a real abdominal sternum and 
abdominal ribs, a more perfect development of what is only indicated 
in man and most other animals. 

§ 1067. The linea alba is sometimes deficient in a greater or less 
portion of its extent, from a primitive deformity, or at least from an 
imperfect development. It often happens that it is torn or accidentally 
distended. 

These original deformities and these consecutive alterations occa- 
sion an abnormal prolapsus of the abdominal viscera, which is called 
umbilical hernia [hernia umbilicalis) when it takes place through or 
near the umbilicus, and is most frequently the cause of ventral hernia 
(hernia ventralis) when it exists in any oilier place. 

V. RECTUS ABDOMINIS. 

§ 1068. The rectus abdominis muscle, Sterno-pubien, Ch., is situated 
on the inner part of the anterior face of the abdomen. It is very long, 
and narrow in proportion to its length, but still more thin than narrow. 
Its thickness gradually diminishes from below upward, while its breadth 
in this direction increases. 

It is attached to the anterior edge and to the lower part of the ante- 
rior face of the cartilages of the fifth, sixth, and seventh ribs by three 
broad slips, of which the internal is the deepest and the external the 
highest. The two internal are the broadest and are generally equal 
in breadth. The external is sometimes much thinner, simply tendinous, 
and adheres to the first slip of the obliquus externus abdominis muscle, 
or is replaced by it entirely ; so that the rectus abdominis muscle ex- 
tends before it to the sixth rib. 

The internal slip is attached also to the anterior face of the xyphoid 
cartilage and its ligaments. 

Below, the rectus muscle terminates by a broad and short tendon, 
which is attached behind the pyramidalis muscle to the upper face of 
the horizontal branch of the pubis. Sometimes this tendon divides into 
two pillars, an external and an internal, the latter of which is broader ; 
although this division is not generally very perceptible. 

The tendons of the two recti muscles are blended with each other at 
their lower part, even partly intercross, and descend from the symphysis 
pubis to the suspensory ligament of the penis. 

The rectus abdominis muscle belongs to the class of poly gastric 
muscles, and exhibits this arrangement more evidently than any other 
muscle. In fact it is always divided into several bellies by undulating 
tendinous intersections, formed of longitudinal fibres. Usually there 
are three of these intersections and hence there are four bellies. 

All these intersections have not exactly the same type. Their ge- 
neral characters are : 

1st. They adhere intimately to the anterior layer of the sheath of 
this muscle. Generally speaking; they are more apparent forward 



94 DESCRIPTIVE ANATOMY. 

than backward, where they are sometimes invisible ; sometimes they 
are seen in one part only. They adhere slightly and usually not at all 
to the posterior layer of the sheath. 

2d. They arc not generally found except above the umbilicus. The 
first is situated about as high as this region, the upper an inch below the 
upper extremity of the muscle, and the central about the centre of the 
space between the other two, although usually a little nearer the upper 
than the lower end. 

Generally the lower two extend completely across the muscle, while 
the upper exists only in its inner part. 

Sometimes however we find a fourth which is imperfect, below the 
umbilicus. Sometimes also one of the superior is deficient or is at least 
imperfect, as is always the case with the third. 

These tendinous intersections are doubtless imperfect representations 
of the ribs in the parietes of the abdomen. 

The rectus muscle is enclosed in a sheath formed by the three broad 
abdominal muscles, with which it is united by mucous tissue. Its 
fleshy portion is but feebly attached to it, but the tendinous intersections 
are very firm. 

The posterior layer of this sheath is deficient at the upper part of 
this muscle, that which covers the costal cartilages to which it is at- 
tached, and at its lower part, from about the centre of the space between 
the umbilicus and the symphysis pubis. In these two parts the muscle 
rests directly on the anterior face of the costal cartilages above, and 
below on the anterior wall of the peritonceum, to which it unites by very 
loose cellular tissue. 

The rectus abdominis muscle contracts the abdominal cavity in the 
direction of length and assists to flex the vertebral column. 

As it unites by its tendinous intersections with the external and 
internal oblique muscles, the effects of its contractions extend to these 
muscles, which in their turn affect the recti muscles. Consequently 
all these muscles act in concert.(l) 

§ 1069. The rectus muscle sometimes presents a fourth slip, which 
arises from the external or internal part of its upper edge, more usually 
from the internal, and goes to the fourth rib. This formation resembles 
that of most mammalia, where it usually reaches to the second rib. It 
leads also by an insensible gradation to the formation of a special ex- 
ternal abnormal sternal muscle. 

This muscle divides in the direction of breadth more rarely than in 
that of length. We have however found on each side external to the 
proper rectus abdominis muscle, between the two obliqui muscles, a 
muscle which extended from the lower edge of the tenth rib to the 
centre of the external edge of the crest of the ilium.(2) This formation 

. (V B f;. tin > Memaire but I'usagc des enervations des muscles droits du bas-ventre, 
in the Mem. dc Pacad. dc Paris, 174G. p 585 
(2) Kelch. loc. cit. p. 42. 



MYOLOGY. 95 

resembles that of birds, in which the rectus abdominis muscle is very 
broad. 

The increase in number of the tendinous intersections of this muscle, 
and especially their existence below the umbilicus, are two circum- 
stances important as being analogous with the formation of the ape.(l) 

VI. PYRAMIDALIS. 

§ 1070. The pyramidalis muscle, Piibio-sous-umbilical, Ch., is situ- 
ated at the lower part of the sheath formed by the tendons of the three 
broad abdominal muscles, and is covered forward by the anterior layer 
of this sheath and backward by the lower part of the rectus muscle. 
It is triangular and oblong ; its base is turned downward and its sum- 
mit upward. It goes obliquely upward and inward and arises from the 
internal portion of the horizontal branch of the pubis, between the inser- 
tion of the external pillar of the descending oblique muscle and the 
sjanphysis pubis, and its summit is attached to the lower part of the 
linea alba. 

It strengthens the linea alba, and contracts the abdominal cavity 
from above downward. 

§ 1071. The pyramidalis muscle is rarely abnormal. It is most 
usually deficient on one or both sides, and then the lower part of the 
rectus muscle is thicker and broader. (2) The absence of this muscle 
is a remarkable analogy with the formation of most animals. 

More rarely it is multiplied on one(3) or on both sides, (4) thus pre- 
senting three or four muscles. 

VII. DIAPHRAGM. 

§ 1072. The diaphragm (septum transversum, diaphragma(,(5) 
a thin and broad muscle, is situated between the pectoral and abdomi- 
nal cavities. It adheres by its upper face to the pleura and pericar- 
dium, and by its inferior face to the peritoneum. Its form resembles an 
inverted figure go, for it is broader from one side to the other than from 
before backward, contracts in the centre, and is circumscribed by 
rounded and convex edges. It arises from the upper lumbar vertebra 
and is attached to the lower six ribs, and generally also to the unciform 
cartilage. 

We may distinguish in it an inferior or lumbar portion (pars himba- 
ris), a superior or costal portion (pars costalis), and a median tendon 
(tendo intermedins.) 

(1) Drelincourt in Blasius, Anat. animal., p. 110. — Vicq. d'Azyr, Encyc.mcth., 
Syst. anat. quadrup., vol. ii. p. 22. 

(2) Santorini, Obs. anat. ch. ix. p. 160. 

(3) Winslow, Exp. anat. p. 36. 

(4) Sabatier, TV. comp/et d'anat., vol. i. p. 263. 

(5) Hallcr, Nova icon, septi transvcrsi, Gottingen, 1741. — Santorini, Tabxdce. anat. 
xvii. Parma, 1775, tab. x. fig. — Tissot, Dcs fonctions du diaphragmc, Montpcllicr, 
1S23. 



96 DEScnirnvE anatomy. 

The lumbar part is much thicker and smaller than the other, and 
arises on each side by four heads from the upper three lumbar verte- 
brae, and terminates in the posterior edge of the central tendon. The 
two halves of this portion represent an X ; in fact they unite in their 
centre and again separate from each other above. 

The four heads (crura), by which each portion of the lumbar part 
arises, follow from within outward and from below upward, so that 
they gradually shorten and go still farther outward and backward. 
Besides, the heads of the two sides are not perfectly similar ; those of 
the left are generally smaller than those of the right. 

The first, the internal or most inferior right head is stronger than 
the left, and arises below it, by a broad tendon, from its half of the 
anterior face of the third lumbar vertebra, sometimes also from ihe 
intervertebral ligament situated between the third and fourth. It is 
the largest of all. 

The second strait head is situated behind the first, arises usually by 
a single tendon, sometimes by two, from the anterior face of the body 
of the second lumbar vertebra. Its muscular fibres are attached 
behind those of the first. 

The third, which is sometimes larger and broader than the.preceding, 
comes from the anterior face of the intervertebral ligament of the first 
and second lumbar vertebrae, and from the lateral part of the body of 
the first. Tt goes upward and outward. 

The fourth arises from the transverse process of the second or first 
lumbar, or even of the last dorsal, vertebrae. 

The heads of the left side generally arise half or even a whole ver- 
tebra higher than those of the right side. 

Between the internal heads we find an oblong rounded transverse 
opening, tendinous at its lower part, which is the most extensive, and 
called the hiatus aorticus, through which the aorta descends, from the 
cavity of the thorax to that of the abdomen. 

When the fleshy fasciculi of the several heads of the same side are 
united(l) those of the right and left side are blended, and partly cross, 
before the upper extremity of the first lumbar vertebra. 

A small part of the internal fasciculus of the left side usually passes 
before the right ; but a much larger portion of the right passes to the 
left, beneath this fasciculus, and forms the most internal portion of the 
left half of the lumbar part of the diaphragm. 

This union is about an inch long. Above its upper extremity the 
lumbar portions of the muscle again separate, and form a longitudinal, 
rounded, and very oblong fissure, called the hiatus ox foramen of the 
esophagus. This opening is from an inch and a half to two inches 
long, and is a little on the left of the median line, and gives passage to 
the esophagus. This opening is formed upward and inward by some 
thin fasciculi of the lumbar portions of the two sides, which incline 
towards each other and are blended together. 

(1) The four heads on each side unite to form the pillars of the diaphragm. 



MYOLOGY. 97 

The upper anterior edge of the two lumbar portions which proceeds 
on each side obliquely downward, outward, and backward, is attached 
to the posterior edge of the median tendon. The external is uninter- 
ruptedly continuous with the costal portion of the muscle. 

The fibres of this part go from below upward. They separate like 
the sticks of a fan. The median tendon is triangular. Its form is 
similar to that of a trefoil leaf, and is broadest in the centre ; its anterior 
edge is convex, and the posterior is concave. It extends from within 
outward, and from before backward, and its anterior and median por- 
tion is nearer the anterior edge of the muscle than the lateral parts are. 

It is formed of tendinous fibres which extend in different directions. 
The strongest and most numerous follow the direction of the fleshy fibres, 
that is, the internal and anterior go forward, those next more obliquely 
outward, the posterior backward, outward, and downward. But on the 
lower face of the tendon we also see others which cross them, and are 
very apparent on the sides, especially toward their posterior edge. The 
latter tend very much to strengthen the tendon. 

We rarely find on a part of the inferior face of this tendon muscular 
fibres separate from the others.(l) 

The right lateral portion of this tendon is perforated at its origin, 
near its central part, towards its posterior edge, and directly before the 
insertion of the lumbar portion ; this opening is of an oblong square 
form, and is called the foramen quadratum, or the foramen of the vena 
cava, and the vena cava inferior passes through it. This foramen 
forms a short canal rather than a simple hole, for its lower edge is situ- 
ated deeper than the upper. The posterior wall of this canal is consi- 
derably higher than the anterior, and is formed by the upper part of the 
right lumbar portion, which is covered with tendinous fibres. Around 
these edges considerable fibrous fasciculi are reflected, the anterior and 
posterior of which go obliquely inward, forward, and upward, while the 
internal and external go downward. 

From the anterior edge, and the external part of the posterior edge 
of this median tendon, the costal portion of the diaphragm arises by a 
very concave edge, and goes outward and backward, where it termi- 
nates by a convex edge. 

The two halves of this portion are blended with each other forward 
and on the median line, but they are separated backward by the lumbar 
portion. 

The anterior fibres are the shortest and the central fibres the longest. 
The anterior go directly forward ; the next in succession became more 
oblique, and finally go transversely outward ; the posterior go from 
before backward, and from within outward. 

The external edge of this part is always attached by rounded slips, 
which are separated more or less distinctly and are sometimes cleft, 
to the internal face of the cartilages of the seventh, eighth, ninth, tenth, 

(1) Huber, in Saemmerring, Wuskellehre, p. 162. 

Vol. J I 13 



98 nF.srniPTivE anatomy. 

and eleventh ribs, and also to the inner face of all the twelfth, and 
usually blends with the posterior edge of the transversalis abdominis 
muscle, which goes forward to meet it. 

The central part of the anterior edge is also most generally fixed to 
the posterior face, and to the lower extremity of the xiphoid cartilage, 
by two thin slips, which go downward and outward. 

Sometimes however these slips do not exist. Their absence must 
be considered as a slight indication of the imperfect union of the right 
and left halves of the body. 

When the diaphragm contracts it acts on the thoracic and abdomi- 
nal cavities ; but its action on them is opposite. In contracting, it rises 
and falls ; its fleshy portion, which is attached backward to the lumbar 
vertebrae, and forward to the ribs, draws the central tendon downward. 
Hence the pectoral cavity is considerably enlarged from above down- 
ward, while the abdominal cavity is proportionally diminished in the 
same direction. The former places the diaphragm among the agents 
of inspiration ; in fact, when the respiration is calm and tranquil, its 
contraction and relaxation produce the alternate motions of inspira- 
tion and expiration. Again, it constantly contributes, by the changes 
it causes in the cavity of the abdomen, to the progress and in general 
the motion of the substances in the alimentary canal, and consequently 
it assists directly in digestion. In this last relation it is an auxiliary to 
the other broad and straight muscles of the abdomen, while it is an 
antagonist to them in relation to the cavit}' of- the thorax. Simulta- 
neous and powerful contractions of the diaphragm and of the other 
abdomuial muscles, produce efforts (nixus)(l) which contract the 
abdominal cavity as much as possible, in order to expel the foreign 
matters actually within or which we believe to be within it, and the 
expulsion of which is unusually difficult. This combined action con- 
sequently takes place in all cases where fcecal matter or urine is 
retained from any cause whatever, as dysentery, inflammation of the 
neck of the bladder, parturition, &c. 

§ 1073. The diaphragm is sometimes wholly or partially deficient 
from a primitive deviation of formation, or it may be torn by some 
mechanical cause acting with violence on it. In both cases, as also 
when the muscle is ruptured, a part of the viscera usually passes into 
the chest through the abdominal opening ; hence results a diaphragm- 
atic hernia [hernia diaphraghmatica) which generally has no herniary 
sac. 

(1) Bourdon (Reehcrchcs sur le mecanisme de la respiration cl sur la circulation du 
sang, Paris 1820) has determined by some interesting inquiries that the functions of 
the diaphragm are confined to inspiration and analogous acts, and that it thus aflccts 
digestion and the abdominal secretions ; but that in respect to these efforts, it only pre- 
pares for them by filling the lungs with air, and that it does not take an active part in 
this phenomenon, since the suspension of respiration, which is tho principal source of 
them, and which depends upon the closing- ofthe glottis, occurs, not during respiration, 
but during the tendency to expiration, which is caused solely by the contraction of 
the abdominal mu F. T. 



MYOLOGY. 99 



ARTICLE SECOND. 

OF THE MUSCLES OF THE CHEST. 



§ 1074. In the pectoral region of the anterior and lateral faces of 
the body we count three superficial muscles, which go from the first 
two sections of the upper extremities to the accessory bones of the 
trunk, and are usually attached to the latter. These muscles are the 
pectoralis major, the pectoralis minor, and the serratus major anticus 
muscles. 



I. PECTOHAH3 MAJOK. 



§ 1075. The pectoralis major muscle, Stermo-humeral, Ch., an ex- 
tensive muscle, the largest and most superficial of those found on the 
anterior part of the chest, is triangular, or, to speak more precisely, is 
irregularly quadrilateral, and is much thicker but much narrower at 
its outer than its inner part. Its smaller upper edge arises by short 
tendinous fibres from the greater inner half of the anterior edge of the 
clavicle. The inner edge, which is larger and concave, also arises by 
very short tendinous fibres, from the anterior face of the handle of the 
sternum, from that of almost all the upper part of the body of this bone, 
and also from the upper edge of the anterior face of the cartilage of the 
fifth rib. A smaller slip is also detached from the rest of the muscle 
in all its extent, which sometimes descends very low, and unites to the 
second slip of the obliquus externus abdominis muscle, as the lower 
outer part of this edge blends with the upper edge of the tendon of this 
muscle and of its upper slip. 

The upper part of the pectoralis major muscle is called the clavicular 
portion (pars clavicularis), the central part the sternal portion (pars 
sternalis), and the lower the costal portion (pars costalis). The last 
however is not separated from the others as the first is. 

The upper fibres of this muscle descend obliquely outward, the cen- 
tral are transverse, and the lower go more and more obliquely upward. 
They all converge towards a very strong tendon, composed of trans- 
verse fibres, which, passing above that of the long head of the biceps 
flexor muscle, goes to attach itself to the lower part of the outer 
rough line of the humerus, and blends in the bicipital groove with the 
tendon of the latissimus dorsi and teres major muscles, unites in this 
place with the lower part of the deltoid muscle, and becomes an apo- 
neurosis, which envelops the muscles of the shoulder. 

This muscle draws the arm, and also all the upper extremity, inward 
and forward, which at the same time is turned on its axis inward and 
depressed if it be raised. Its central and transverse portion goes directly 
inward and forward ; the upper portion raises the arm, the lower 
depresses it. 



100 DESCRIPTIVE iNATOMV. 

§ 1076. The clavicular portion of this muscle is very often entirely 
separated from the stomal portion, so that a considerable space exists 
between them, and on the anterior edge of the latter we see several 
fissures of different depths. This formation is very analogous with 
that of the mammalia, in most of which the pectorahs major muscle is 
divided into several distinct muscles. 

A considerable muscular band is sometimes detached from the pec- 
toralis major muscle, which goes to the arm, where it is attached either 
to the aponeurosis, or to the short head of the biceps flexor, or 
finally to the latissimus dorsi muscle, which arrangement resen 
the common muscle of the arm, shoulder, and head, found in animals 
destitute of a clavicle. 

§ 1077. On the anterior face of the pectoralis major muscle, more or 
less distant from its inner edge, directly between it and the cellular coat, 
we often find a supernumerary muscle, called from its situation the tho- 
racic, the straight sternal or the sternal muscle of animals (JVI. tho- 
racicus, rectus sternalis, sternalis brutorum). 

This muscle is a more or less perfect repetition of the rectus abdo- 
minis and of the sterno-cleido-mastoideus. It often unites these two 
muscles, or at least extends from one to the other ; sometimes also it 
is unconnected with either, and is attached by its upper extremity to 
the handle of the sternum and by the lower to the costal cartilage or to 
the lower part of the sternum : its two extremities are often blended 
with the pectoralis major muscle. In certain cases it is indicated only 
by a tendon, which extends from the sterno-cleido-mastoideus to the 
rectus abdominis muscle, or by an unusually long slip of the latter. 

The accessory muscle varies in thickness, breadth, and even in num- 
ber, no less than in its length. In fact its thickness is sometimes only 
a few lines and is sometimes several inches ; sometimes it exists only 
on one side, sometimes also it is double either on one or on both sides ; 
sometimes we number four of these muscles. 

In certain subjects there are transverse tendinous intersections, which 
render it still more analogous to the rectus muscle : these intersections 
are not common. 

The side of the body and the sex of the individual seem not to influ- 
ence the existence of this muscle.(l) 

It is curious inasmuch as it establishes a relation between man and 
animals, renders the analogy between the anterior and posterior halves 
of the body more sensible than it is generally, and particularly renders 
the whole anterior face more uniform. 
It is not peculiar in blacks. 

(1) For farther details on this interesting- muscle, see Sandifort, Demvsc. nonmdlis 

quirarius occurrunt, in the Excrc. acad. Book i. ch. vi. p. 82-88. Meckel De monstr. 

duplicitate, Halle, 1815, p. 35-40.— Kelch., Bcytrwge, p. 33, No. 25. 



MYOLOGY 101 



II. PECIOHALIS MINOR. 



§1078. Directly below the pectoralis major we. find the pectoralis 
minor muscle, Coslo-coracoidien, Ch., (JVf. pectoralis minor, s. serratus 
anticus minor), which is much smaller. The form of this muscle is an 
elongated triangle, the base of which looks downward and forward, 
and the summit is turned upward and backward. 

Its anterior edge is generally attached by three, more rarely by two 
or four slips, all of which proceed equally far forward but at unequal 
distances from each other, to the anterior face and upper edge of the 
third, fourth, and fifth, rarely also the sixth lib. 

A fourth slip is sometimes found behind the second, and more or less 
covered by it and also by the third, which is inserted in the outer face 
of the fourth rib. 

The upper and the posterior or lower edge, which are much longer 
than the anterior and which are nearly equal in length, are loose and 
unite above in a tendon, which is attached to the anterior edge of the 
summit of the coracoid process of the scapula. 

The pectoralis minor muscle is much narrower but also much thicker 
at its upper than at its lower part. 

It draws the coracoid process and consequently the scapula forward, 
downward, and inward. When the scapula is fixed, this muscle raises 
the ribs to which it is attached. 

§ 1079. Sometimes we find a curious analogy with the formation- of 
birds in the existence of a third pectoral muscle below these : this arises 
from the first and second ribs by separate digitations, and is attached 
to the coracoid process of the scapula.(l) A similar anomaly consists 
in a band, which sometimes comes from the upper rib, and which, 
covered by the pectoralis minor muscle, ascends to the capsular liga- 
ment of-the scapulo-humeral articulation.(2) 



III. SERRATUS MAJOR ANTICUS. 



§ 1080. The serratus major anticus muscle, Costo-scapulaire, Ch., 
is a broad, thin, and triangular muscle, the base of which is downward 
and the summit upward. It covers in great part the lateral region of 
the upper eight ribs. 

Its anterior concave edge arises by nine triangular slips, of which 
the lower four are situated farther forward than the others, from the 
bony parts of the first eight ribs, nearer their anterior than their poste- 
rior extremity. 

The number of slips then exceeds that of the ribs, because the second 
and third, one of which is often deficient, are attached together to the 
second rib. The four lower slips intercross with the upper four of the 

(1) Rosmmiiller, p. 6. (2) Gantzcr, p. 11. 



1 02 DESCRIPTIVE A1T4T0M1 

obhquus cxternus abdominis muscle. The lower edge is loose. The 
posterior is attached to all the internal lip of the inner edge of the 
scapula. 

The upper fibres descend obliquely forward and inward : the central 
are transverse; the lower fibres have the same direction as the upper, 
but are less perpendicular than they. 

This muscle generally draws the scapula and with it all the upper 
extremity forward and inward: When this bone is fixed it carries the 
ribs to which it is attached* outward and backward. 

§ 1081. Sometimes but very rarely the central portion of theserratus 
major muscle is deficient, so that it is completely divided into two 
unconnected parts. 

IV. TRIANGULARIS STERN!. 

§ 1082. The triangularis slerni muscle, Sterno-costal, Ch., is thin; 
it is situated upon the inner face of the sternum and costal cartilages, 
and is formed of several successive sbps placed over each other. It 
arises by a thin and broad tendon from the edge of the under part of 
the body of the sternum, from the ensiform cartilage, and from the inner 
face of the costal cartilages from the third to the sixth or seventh. Its 
fibres are oblique and go to the cartilages of the second, third, fourth, 
and fifth ribs, to which they are attached by long digitations. 

Of all the muscles this is one of the most variable. Sometimes one 
or more slips are deficient, and the internal edge is not attached to the 
costal cartilages but only to the inner face of the sternum ; and again 
several slips are formed which are entirely isolated, or at least some of 
them are not connected with the others. 

It is always continuous at its lower extremity by tendinous fibres 
and often by its fleshy portion with the upper end of the transversalis 
abdominis muscle ; so that in many cases, but not however in all, we 
may consider it as forming but one with it and call it the slerno-abdo- 
minal muscle (JM. sterno-abdoininalis).{\) 

It at least always represents in the thorax the transversalis abdo- 
minis muscle. This comparison terminates the analogy betwen the 
muscles of the abdominal and thoracic parietes. 



ARTICLE THIRD. 

OF THE ANTERIOR MUSCLES OF THE NECK. 

§ 1083. The anterior muscles of the neck form a superficial and a 
deep layer. 

(1) Rosenmiiller, De rwnnullis musculorum corp. hum. varietatibus, Leipsic, 1814. 



MYOLOGY. 103 



1. SUPERFICIAL LAYER. 



§ 1084. The superficial layer of the anterior muscles of the neck is 
situated in front and on the sides of the larynx, the trachea, the pha- 
rynx, and the hyoid bones. It comprises the platysma myoides, the 
sterno-cleido-mastoideus, the sterno-hyoideus, the omo-hyoideus, the 
sterno-thyroideus, and the muscles which extend from the larynx to 
the hyoid bones, from the thyroid to the cricoid cartilages, and from the 
skull to the hyoid bones and to the pharynx. We shall mention in 
this place only the first two. The others will be described with the 
organs of digestion and of voice, — 1st, because their points of attach- 
ment have not yet been described ; 2d, because it is more convenient 
to refer the history of those which are inserted in parts already de- 
scribed, as for instance the muscles of the hyoid bones, to that of the 
muscles near them, which are intimately connected and always act 
with them. 



I. I'LATVSMA MYOIDES. 



§ 1085. The platysma myoides muscle, Thoraco-facial, Ch., (M. 
latissimus colli, s. platysma myoides, s. qnadratus, s. letragonus geme), 
has an oblong scmare form. It is very thin and composed of muscular 
bands, which are generally very loosely united and often have consi- 
derable spaces between them. It is situated directly below the cellular 
tissue, to which it adheres, and arises in the thoracic and scapular 
region by separate bands, which extend a little below the clavicle, so 
that it covers part of the upper edge of the deltoides and pectoralis major 
muscles. It gradually contracts, becomes thicker, and going obliquely 
upward, inward, and forward, on the side of the neck, attains the lower 
part of the face, where it is attached partly to the under edge of the 
lower maxillary bone, and partly blends with the levator anguli oris 
muscle and ascends to the corner of the mouth, and partly loses itself 
below the adipose covering of the face. 

It wrinkles the skin which covers it and draws the mouth downward 
and outward. The latter motion is executed particularly by the last 
fasciculus, hence called the risorius Santorini muscle. 

This muscle is evidently only a rudiment of the intercostales and of 
the broad abdominal muscles in the neck, as is proved by its situation, 
its relations with the other muscles and the common integuments, and 
by the direction of its fibres. The looseness of its lower edge, which is 
wholly unattached, corresponds very well with the arrangement of the 
anterior part of the lower edge of the broad abdominal muscles, as like- 
wise its insertion in the lower maxillary bone resembles that of the 
upper edge of these muscles in the ribs, to which the lower maxillary 
bone is analogous. 



104 BESCRITTIVE ANATOMY. 

Its less degree of development depends partly on the smallness of the 
region in which it is found and partly also because there is no special 
cavity in it. 

§ 1086. A special fasciculus frequently but not always arises from 
its upper part and goes toward the face. This fasciculus is sometimes 
loose under the cellular tunic and sometimes arises from the tendon of 
the massetcr muscle. It goes from behind forward and is attached with 
the platysrna to the angle of the lip; it is sometimes replaced by the 
upper part of the latter which is broader. 

It is more rare to find an inferior slip arising from the clavicle, which 
extends under the skin to near the deltoid musclej where it disappears 
in the cellular tissue ; it resembles the fleshy coat of animals.(l) 

We also rarely find a small transverse muscular slip between the 
platysrna and the skin, below the chin. (2). 

We more rarely see the platysrna not thin and superficial as usual 
but rounded and thick, not proceeding forward but going backward 
and attached to the occipital bone. (3) 

II. 67ERNO-CLEIDO-MASTOIDECS. 

§ 1087. The sterno-cleido-mastoideus muscle, Siemo-mastoidien, Ch., 
must be regarded not as a single muscle but as the union of two mus- 
cles, since its two bellies are more distinct from each other than some 
other muscles, especially those of the dorsal region, which are consi- 
dered as separate. 

The anterior belly, the stemo-masloideus muscle(J\I.sterno-mastoideus ) 
s. nutator capitis anterior), arises by a short but strong tendon from the 
most upper and outer part of the anterior face of the handle of the ster- 
num. It is elongated and rounded and becomes insensibly broader and 
thinner at its summit, goes obliquely upward and backward, and is 
attached to the outer face of the mastoid process of the temporal bone 
and to a small part of the outer face of the upper curved line of the 
occipital bone. 

The posterior belly, the cleido-masioideus muscle (JVJ. cleido masloi- 
dcus, s. nutator capitis posterior), is shorter and weaker than the pre- 
ceding. It arises an inch more outwardly, from the upper edge and 
the upper part of the anterior face of the sternal part of the clavicle 
(but it does not come from its inner edge) by a thin and broad tendon ; 
it descends obliquely but straighter than the preceding, gradually be- 
comes round, and terminates in a point, where it is attached below the 
preceding, to the lower part of the outer face of the mastoid portion of 
the temporal bone by a rounded tendon, which covers its upper portion 
and with which it is united by some separate fibres. 

(1) Gantzcr, lac. >;it., p. 111. 

(2) Fleischmann, in Erlangcr Abhandl., vol. i. p. 28.— Ganlzer, log. cit., p. 6. 

(3) Zagwsky. Mem. clc Pacad. de Petcrsburgh, vol. j. p. 357. 



MTOLocr. 105 

These two muscles correspond from above downward, the first to the 
rectus abdominis and the second to the pyramidalis muscle, in this 
respect, that they are more similar than the latter in regard to size. 
They represent also from before backward the splenii muscles, to which 
they are antagonists. 

The sterno-cleido-mastoideus muscle inclines the head obliquely for- 
ward, so as to bring the face from the opposite side. When the two act 
in concert the head is flexed. The external belly draws it more directly 
forward and downward, and the inner belly more obliquely from the 
opposite side. 

§ 1088. The greatest anomaly of this muscle is an increase in num- 
ber, arising from the detachment of some fasciculi from the rest of 
the mass.(l) 

Thus for instance we not unfrequently find between the two bellies a 
special and smaller fasciculus, which sometimes continues separated as 
far as its upper extremity, or which before arriving there blends with one 
of the other two ; this generally arises directly at the side of the ante- 
rior belly, either on the outside of it from the sternum or from the most 
internal part of the sternal end of the clavicle. 

We less frequently find a thinner and usually very broad accessory 
muscle, which arises from the clavicle behind the second belly, ascends 
behind it from before backward, and attaches itself on the outer side of 
it to the occipital bone. 

The numerous divisions and multiplications of this muscle remind us 
of the analogy between it and the rectus abdominis and pyramidalis 
muscles. 

Nor is it rare to see a fleshy or tendinous slip which extends from 
the lower edge of the sterno-mastoid portion to the angle of the lower 
maxillary bone. (2) 

All these varieties form so many analogies with animals; for in 
most mammalia the sterno-mastoid and cleido-mastoid portions are 
almost entirely separated from each other, and the latter is most fre- 
quently doubled. Besides, this always increases in volume and num- 
ber outwardly ; this circumstance establishes a manifest relation with 
the formation in most mammalia, in which the cleido-mastoideus muscle 
is generally blended with the clavicular portion of the deltoides muscle ; 
even in the solipedes, the sternal portion extends only to the lower 
maxillary bone. 

II. DEEP LAYEK. 

§ 1089. The deep layer of the anterior muscles of the neck is situ- 
ated directly on the anterior face of the upper part of the vertebral 
column. It comprises the rectus capitis anticus major, the rectus capi- 

(1) G. Meckel, De duplicitate monstrosa, p. 40, 41. — Kelch, Beytrcege zur path, 
anat.yj). 31. 

(2) Brug-none, p. 160. 

Vol. II. , 14 



106 DESCRIPTIVE ANATOMT. 

tis minor, aad the longus colli muscles, all of which serve to bend the 
head and neck. 

I. RECTUS CAPITIS ANTICUS MAJOH. 

§ 1090. The rectus capitis anticus major muscle, Grand trachtlo- 
sous occipital, Ch. (M. rectus capitis anterior, s. internus, s. major), ia 
oblong and thicker at its upper than at its lower part. It generally 
arises by five thin and tendinous slips, which increase in size from 
below upward, from the transverse processes of the third, fourth, fifth, 
and sixth cervical vertebrae, and from one slip of the longus colli mus- 
cle, which is attached to the sixth cervical vertebra. It goes from below 
upward and from without inward, gradually approaching its congeni- 
tal. It is mostly strongly tendinous. Its upper edge is attached 
directly before the large occipital foramen to the basilar process of the 
occipital bone. 

It bends the head directly forward. 

§ 1091. We sometimes find two additional upper tendinous slips 
which come from the first and second cervical vertebra, an arrange- 
ment resembling the formation of the carnivorous animals. 



II. RECTUS CAPITIS ANTICUS MINOR. 



§ 1092. The rectus capitis anticus minor muscle, Petit trachelo-sotts 
occipital, Ch. (JkT. rectus capitis anterior, s. internus, s. minor), is a 
smaller, thinner, and triangular muscle, which gradually enlarges from 
below upward. It arises above and forward from the anterior arch and 
from the root of the transverse process of the first cervical vertebra, as- 
cends, covered by the preceding, before the articular ligament between 
the occipital bone and the first cervical vertebra, goes obliquely inward, 
and is attached before the occipital foramen to the basilar process, and 
more outwardly to [the fibro-cartilaginous mass which fills the space 
between the body of the occipital bone and the petrous portion of the 
temporal bone. 

It bends the head forward and a little to the side. 



HI. LONGUS COLLI. 



§ 1093. The Longus colli muscle, Predorso-atloidien, Ch., descends 
from the first cervical to the third or fourth dorsal vertebra. Its struc- 
ture is very complicated, and we may consider it to a certain extent 
as formed of two muscles, an upper and lower, which are united. 

The internal is smaller, and goes directly downward and a little 
outward. It arises by separate tendinous slips from the side of the 
body, and the intervertebral cartilages of the upper three dorsal verte- 
brae, and also from the body and the anterior roots of the transverse pro- 
cesses of the lower four cervical vertebrae, ascends in a straight line, 
and is attached externally, by two or three short tendons, to the ante- 



MYOLOGY. 107 

rior tubercle of the transverse processes of the fourth and fifth cervical 
vertebrae ; and inward, by a strong tendon, to the anterior face of the 
bodies of the second and third cervical vertebrae. 

The upper muscle is stronger than the preceding, and is directly 
continuous with it ; it arises by small tendinous slips from the anterior 
roots of the transverse processes of the third, fourth, and fifth cervical 
vertebrae. It ascends obliquely inward, gradually becomes straighter, 
and is attached to the anterior tubercle of the first cervical vartebra, 
seldom to the basilar portion of the occipital bone. 

The longus colli muscle bends the neck forward, and a little to the 
side. 



ARTICLE FOURTH. 

OF THE SACRO-COCCYGCEAL MU8CLE8. 

§ 1094. The sacro-coccygceal muscles (J\I. sacro-coccygcci, s. curva 
tores coccygis) are not constant. When they exist they appear as 
small, elongated, thin, and mostly tendinous fasciculi, situated on the 
two sides, which arise from the anterior face of the la8t sacral and first 
coccygoeal vertebra, and are attached by several slips to the anterior 
face of the lower pieces of the coccyx, where that of" the right and left 
are usually blended. 

They draw the lower pieces of the coccyx forward and upward, bo 
as to curve the whole range of these bones. 

These muscles are the rudiments of the caudal flexors in animals. 
They evidently correspond to the three muscles of the upper half of 
the body, which we have just described. 



SECTION II. 

OF THE MUSCLES OF THE HEAD. 

§ 1095. The muscles of the head comprise those of the skull and 
those of the face. 

The muscles of the skull are the occipito-frontalis, the auricular 
muscles, and one muscle of the lower jaw. 

The muscles of the face are those of the eyes, the nose, the lips, the 
other muscles of the lower jaw, and the hyoid muscles. 

Of these muscles we shall here examine only the occipito-frontalis, 
and those of the lower jaw, both because the parts which must neces- 
sarily be known to understand the descriptions of the others are not 
yet mentioned, and also because it is more convenient to examine them 



108 DESCRIPTIVE ANATOMY. 

in connection with the other constituent parts of the organs which they 
assist to form. 

I. OCCIPITO-FRONTALIS. 

§ 1096. The occipitn-frontalis or epicranial muscle (M. epicranivs, 
s. cranii culaneus, s. occipitofrontalis) is a flat, digastric muscle, situ- 
ated directly under the skin, to which it is intimately attached, and 
covers the anterior, upper, and posterior parts of the skull, and also the 
central and upper part of the face. 

Its posterior belly, which is also described as a separate muscle, 
termed the occipitalis, has an oblong square, or triangular form. It 
arises by tendinous fibres from the root of the mastoid process, and 
from the upper occipital ridge of the. basilar bone, where it unites with 
the sterno-cleido-mastoideus and trapezius muscles, soon becomes fleshy, 
ascends on the squamous portion of the occipital bone, and terminates 
by a concave edge which unites with the median tendon. 

This tendon is called the skull-cap (galea capitis), and is formed of 
very distinct longitudinal fibres. It extends all along the skull to the 
frontal bone, where it is attached to the anterior belly or the frontalis 
muscle. 

The anterior belly or the frontalis muscle is much more exten- 
sive than the posterior. It begins by an upper convex edge, then 
descends along the squamous portion of the temporal bone, goes 
straight to its inner part, which is the thickest, and obliquely forward 
to the outer, which is thinner, and terminates as follows : at its inner 
part, it is continuous by several slightly tendinous slips with the pyra- 
midalis nasi and the levator labii superioris alceque nasi muscles ; in 
the region of the inner angle of the eye, it is attached to the nasal pro- 
cess of the upper maxillary bone and to the lower portion of the frontal 
bone ; finally, at its outer part, it blends with the corrugator supercilii 
and the orbicularis palpebrarum muscles. 

Tho occipito-frontalis muscle corresponds in situation and attach- 
ment to the interspinales muscles of the vertebrae. It resembles one of 
these muscles which is enlarged, rounded, and divided in its centre, 
from before backward, into two parts, united by an intermediate tendon. 

Considered as a whole, this muscle moves the skin of the top of the 
head. Its two bellies wrinkle in a transverse direction the skin above 
them, and extends that, near, them when they contract from the side of 
their tendon. Thus the frontal muscle raises that of the upper part of 
the neck. 

II. MUSCLES OF THE LOWER MAXILLARY RONE. 

§ 1097. The muscles of the lower maxillary bone comprise those 
which raise it, those which move it to the side, and those which 
depress it. 



109 



I. LEVATORS OF THE LOWER JAW. 



§ 1098. The lower jaw is moved by three levators, the action of 
which is to bring it towards the upper jaw, which is fixed. These are 
the temporalis, the masseter, and the pterj r goideus intemus muscles. 



A. TEMPORALIS. 



§ 1099. The temporalis muscle, Temporo-maxillaire, Ch., the largest 
and strongest of all the muscles of the lower jaw, is broad and trian- 
gular. It occupies all the lower region of the central part of the lateral 
face of the skull, for it fills the temporal fossa, and covers the plain 
semicircular surface. 

It arises by very short tendinous fibres and by a convex edge from 
the semicircular line which bounds the lower part of the outer face of 
the frontal bone, from the large wing of the sphenoid bone, from the 
parietal bone, and the squamous portion of the temporal bone, and by 
fleshy fibres from the parts of these same bones situated below this 
line. Its posterior fibres go from above downward and from behind 
forward, the central are almost perpendicular, the upper go from above 
downward and from before backward ; all converge to unite in the 
temporal fossa. 

As they leave the circumference the muscle becomes narrower and 
thicker, and terminates in a short but very strong tendon, which is 
attached to the coronoid process of the lower maxillary bone. 

The entire muscle is covered externally by a tendinous expansion, 
formed of descending fibres which arise immediately over it, serves for 
the attachment of its fibres above, is separated below, on its outer face, 
by a greater or less quantity of fat, and is very loosely united to it in 
this place by cellular tissue and vessels, and is attached to the poste- 
rior edge of the malar bone and also to the upper edge of the zygo- 
matic arch. 

This muscle draws the lower jaw forward and upward. 



B. MABSETER. 



§ 1100. The masseter muscle, Zygomato-maxillaire, Ch. (M. masse 
ter, s. mandibidaris extcrnus), has an oblong square form. Its length 
exceeds its breadth, and it is formed of fibres which go upward. It 
covers the outer face of the ascending branch of the lower maxillary 
bone, and fills the space between the posterior part of the lower edge 
of this bone and the zygomatic arch. 

It is very evidently formed of two layers entirely separate from each 
other, which differ also in the direction of their fibres, and which may 
be regarded as two distinct muscles. 

The anterior external layer is the longest and strongest, and covers 
most of the lower. It is formed of fibres which are oblique from above 



110 DESCRIPTIVE ANATOMY. 

downward and from before backward, and become a little narrower 
from below upward. It arises by short tendinous fibres from the lower 
edge of the malar bone, and is attached to the lower half of the ascend- 
ing branch of the lower maxillary bone, as far as its inferior edge and 
its angle. 

The inferior or posterior layer is much smaller and feebler than the 
preceding ; its form is also square, and it is composed of fibres which 
go backward. It becomes thicker from below upward, is loose poste- 
riorly, and is covered anteriorly by the preceding layer. It arises by 
fleshy fibres from the lower edge of the posterior part of the zygomatic 
arch, and is attached by short tendinous fibres above the upper end 
of the insertion of the external layer in the centre of the outer face 
of the ascending branch of the lower maxillary bone. 

The two layers unite and draw the lower jaw upward, the ex- 
ternal brings it forward, and the internal backward. 

C. PTBBTG0IDEU6 IN TERN US. 

§ 1101. The pterygoidetis internus muscle, Grand ptereygo-maxil- 
laire, Ch., an oblong quadrangular muscle, arises by its upper thick edge 
from all the pterygoid fossa of the pterygoid process of the sphenoid 
bone, goes obliquely downward and outward and is attached, opposite 
the preceding, but to a much less extent than it, to the lower part of 
the inner face of the ascending branch of the lower maxillary bone, as 
far as the angle. 

It draws the jaw upward and inward ; but if the muscles of both 
sides act, the jaw is moved directly upward. 

II. PTERYOOIDEUS EXTERNUS. 

§ 1102. The lower jaw is moved laterally by a single muscle, the 
pterygoideua externus muscle, Petit ■pUrygo-maxillaire, Ch., situated 
between the lower maxillary bone and the pterygoid process. This is 
the smallest muscle of the lower jaw, and differs from the others in the 
transverse direction of its fibres. It arises by short tendinous fibres 
from all the outer face of the outer layer of the middle sphenoid or 
pterygoid process, then goes directly backward and outward, and ia 
inserted by short tendinous fibres in the inner face of the neck, and of 
the condyle of the lower maxillary bone. 

It draws the lower jaw from the opposite side, that is inward and 
forward, when it acts alone ; but forward only when it contracts with its 
synonymous muscle of the other side. 



MYOLOGY. HI 



lit. DIGABTRICUS. 



§ 1103. Although several muscles contribute more or less directly 
to depress the lower jaw,(l) there is however but one appropriated 
specially to this function ; this is the digastricus muscle, JSlasioido- 
genien, Ch., (Jtf. biventer maxillm inferioris), so named because formed 
of two oblong bellies united by a central tendon. 

The posterior longer and stronger belly is more rounded than the 
other and arises from the mastoid fissure of the temporal bone, and is 
covered in this part by the upper end of the sterno-cleido-mastoideus 
muscle. Leaving this point, it goes downward, forward, and inward, 
and gradually becomes a thinner oblong median tendon, which is at- 
tached by a small tendinous expansion on its anterior extremity to the 
lateral end of the central piece of the hyoid bone ; so that it is situated 
between the temporal and hyoid bones. 

The anterior belly is shorter and flatter than the posterior, and arises 
behind the median tendon ; goes forward and inward, and is attached 
directly at the side of the synonymous belly of the opposite side to the 
centre of the inner lip of the lower edge of the jaw. 

This muscle draws the lower jaw downward and backward. If the 
posterior acts alone, it raises the hyoid bone and draws it backward. 
If the anterior acts singly, this bone is also raised but carried forward. 
When the posterior belly contracts behind and the anterior before, it 
draws the skull and the face, except the lower jaw, backward, and 
thus by its action on the skull raises the upper jaw, separates it from 
the lower, and opens the mouth. 

§ 1104. A very common anomaly of this muscle consists in the 
union of the anterior bellies of the two sides with each other and with 
the pterygoideus externus muscle, by the formation of a larger or smaller 
fleshy portion. (2) Sometimes too we find between it and the skin a 
special transverse fasciculus, which is extended between the branches 
of the lower maxillary bone.(3) 

These anomalies are evidently imitations of what is seen in several 
mammalia, where the anterior bellies even blend with each other. 

More rarely the anterior belly does not extend to the chin, but is 
attached to the centre of the horizontal branch of the lower maxillary 
bone, as is also the case in many mammalia, where the single muscle, 
with which it is provided is also inserted more posteriorly than in man 

(1) A Monro, Remarks on the articulation, muscles, and luxation of the lower jaw, 
in the Edinburgh medical Essays,vol. i. p. 103-129. — J. C. Plainer, De musculo digas- 
trico maxillae inferioris, Leipsic, 1737. — Winslow, Observ. par Panatomie comparee 
surP usage des muscles digastriques de la machoire inferieure dans Phomme, in the 
Mem. de Paris, anno 1 742, p. 236. 

(2) G. Meckel, De duplic. monstr., p. 42. 

(3) FUiachmann, in the Erlanger Abhandl., vol. i. 



112 DESCRIPTIVE ANATOMY. 

SECTION II. 

OF THE MUSCLES OF THE EXTREMITIES. 

§ 1 105. The muscles of the extremities form the greater part of these 
sections of the body. Most of them have a more or less elongated 
form and assume a longitudinal direction, although this is not the direc- 
tion of their fibres, which go obliquely from one or more edges to the 
tendons. Very few of them have a transverse direction or one inter- 
mediate between it and the preceding : the latter are shorter. 

The muscles which follow the longitudinal direction flex and extend 
the different parts of the limbs ; the transverse and the oblique separate 
them from each other or turn them on their axes. 

The muscles of both extremities are surrounded with general tendi- 
nous sheaths (fasciae aponeurotic or) and the tendons of the inferior, which 
are the longest in proportion, and are firmly attached in several places 
by strong fibrous ligaments to the bones over which they pass. 

In regard to situation, arrangement, and number, they correspond 
perfectly in their essential particulars, and differ only in modifications 
dependent on the different functions of the two limbs. 

CHAPTER I. 

MUSCLES OF THE UPPER EXTREMITIES. 

§ 1106. The muscles which move the first section of the bones of 
the upper extremity, or the bones of the shoulder, all come from the 
bones of the trunk, from which arise also some of those which move 
the bone of the second section — the humerus. The former are 
the trapezius, the rhomboidei, and the levator anguli scapulae; the 
others the pectoralis major and the latissimus dorsi muscles, which 
have already been described (§ 1001). 

It is convenient to commence the description of these muscles by that 
of their common aponeurotic sheath. 

ARTICLE FIRST. 

OF THE APONEUROTIC SHEATH OF THE UPPER LIMBS. 

§ 1107. The muscles of the upper extremities arc surrounded by a 
tendinous envelop called the brachial aponeurosis (fascia brachialis). 



MYOLOGY. 



113 



This arises in very muscular subjects from the deltoid muscle, but 
sometimes we do not see it except below this muscle. It is always 
stronger on the fore-arm than on the arm. However, at the posterior 
part of the anterior and posterior faces it is always much thicker than 
on the other faces and strengthened by transverse and oblique fibres, 
which cov : the longitudinal fibres externally. 

In most of its extent it envelopes the muscles externally only. How* 
ever, at tl lower end of the arm, in the inner angle, there is a triangu- 
lar slip, the internal and external intermuscular ligament (L. intermuscu- 
lare internum et externum), which leaves the aponeurosis and goes for- 
ward. The external extends from the outer condyle to the upper ex- 
tremity of the projecting part of the anterior angle ; the internal from 
the inner condyle to the corresponding point of the inner angle. They 
extend between the extensors and flexors of the fore-arm and increase 
their surfaces of attachment. 

Two similar but much weaker ligaments are also found in the fore- 
arm in a similar situation. They separate the flexors and the extensors, 
both on the ulnar and radial side ; because they proceed from the 
inner face of the aponeurosis to the posterior edge of the ulna and of 
the radius to which they are attached. 

Near the lower end of the fore-arm, the transverse fibres disappear, 
or at least become evidently thinner ; but they again accumulate on 
the end of its posterior face and on the back of the thumb, become 
much more thick than high, and give rise in this place to the dorsal 
ligament of the carpus (Lig. carpi dorsale, s. armillare). 

This ligament extends from the transverse process of the radius to 
the small head of the ulna, the pisiform, and the tuberosity of the fifth 
metacarpal bones. It is formed at its upper part, which is the weakest, 
of transverse fibres, which descend from the ulna to the radius, and at 
the lower part of fibres, which go backward and downward from the ra- 
dius, and consequently partially cross the preceding. 

Under it pass the tendons of the abductor magnus and extensor pol- 
licis, the radiales externi, the extensor digitorum communis, the ex- 
tensor indicis proprius, the extensor minimi digiti proprius, and the 
ulnaris externus muscles. Their passage is facilitated by the 
partitions which descend from the inner face of the ligament to the 
asperities on the ends of the bones of the fore-arm and divide it into six 

parts. ^ 

The first, the anterior, extends from the anterior edge of the lower 
end of the radius to the first asperity on the back of this bone, and con- 
tains the tendons of the abductor pollicis longus and of the extensor 
pollicis brevis muscles. 

Through the second, which is larger and which extends from the 
first dorsal asperity to the second, pass the tendons of the two radialei 
externi muscles. 

The third, a little oblique forward and downward, extends from tfr 
second to the third dorsal asperity of the radius, to the posterior edge 

Vol. II. 15 



114 DESCRIPTIVE ANATOMY. 

of its lower extremity, and lodges the tendon of the extensor pollicis 
longus muscle. 

The fourth, the largest, extends from the third dorsal eminence to 
the posterior edge of the radius, and receives the tendons of the exten- 
sor digitorum communis and extensor proprius indicis muscles. 

The fifth, the smallest, is comprised between the radius and the 
anterior edge of the small head of the ulna ; it receives the tendon of 
the extensor minimi digiti proprius muscle. 

Finally, the sixth, which extends from the posterior edge of the small 
head of the ulna to its styloid process, embraces the tendon of the ulnaris 
externus muscle. 

The lower edge of this ligament, which should be regarded not as 
a separate ligament but only as the development of the brachial apo- 
neurosis, is uninterruptedly continuous with the aponeurosis of the 
back of the hand, which gives a loose common envelop to the tendons 
of the extensor muscles, blends with the oblique tendinous fibres by 
which the tendons of the extensors of the fingers are retained in place, 
and concurs to form them. 

The brachial fascia is also strengthened at the lower part of the an- 
terior face of the fore-arm and on the palmar side of the carpus. 

The upper part of this portion, which is the feeblest and which extends 
from the anterior edge of the radius to the pisiform bone, forms the 
common palmar ligament of the carpus {Lig. carpi volare commune). 
It unites at its ends with the dorsal ligament. Under it pass the tendons 
of the flexors of the fingers, and in a special sheath that of the radialis 
internus. 

The lower part, which is much stronger, forms the proper palmar 
ligament of the carpus (Lig. carpi volare proprium). This ligament 
is formed by transverse and oblique fibres. Above, it blends in great 
part with the preceding. Below, it strengthens the palmar aponeu- 
rosis. Its two edges arise from the palmar eminences of the carpus, 
which are formed on the radial side by the trapezium and the pyramidal 
bones and on the ulnar side by the pisiform and unciform bones. 

ARTICLE SECOND. 

MUSCLES OF THE .SHOULDER. 

§ 1108. The muscles of the shoulder, which surround the scapula 
and which extend from this bone and also from the clavicle to the hu- 
merus, are the deltoides, the supraspinatus, the infraspinatus, the teres 
major, the subscapularis, the teres minor, and the coraco-brachialis 
muscles. 

I. DELTOIDES, OR THE EXTENSOR OF THE ARM. 

§ 1109. The deltoides muscle, Sus-acromio-humeral, Ch. (M. del- 
toides, levator, attollens humeri), is a very strong muscle, which occupies 



MYOLOGY. 115 

the upper and anterior part of the region of the shoulder. It arises by 
its upper longest and concave edge from the anterior edge of the sca- 
pular end of the clavicle, from the anterior edge of the acromion process, 
and from the lower edge of all the spine of the scapula at its anterior 
part, by fibres almost entirely fleshy or which at least have very short 
tendons, and by very long tendinous fibres at its posterior. 

After leaving this point, the muscle gradually becomes thicker, goes 
downward, and terminates by a fleshy summit externally, but possessing 
within a very long tendon, which is attached directly below the tendon 
of the pect oralis major muscle, at the posterior end of the external linea 
aspera, which arises from the outer tubercle of the humerus and at the 
central part of the outer face of this bone, which presents in this place 
a triangular impression. 

These fibres converge from above downward ; so that the central 
are straight, the anterior oblique from before backward, and the poste- 
rior from behind forward. 

In examining this muscle more attentively, we recognize that it ig 
composed of two orders of triangular fasciculi. The first order con- 
tains four fasciculi, which are larger than the others and the bases of 
which are turned upward and their summits downward. Between are 
the three smaller fasciculi of the second order, which are broader 
below than above but the two ends of which are a little narrower than 
the central part. 

Below the upper edge of this muscle, between it and the capsular 
ligament, we find a considerable mucous bursa, which corresponds 
usually to the acromion, extends between this last process and the 
proper anterior ligament of the shoulder, and sometimes divides into 
two bursa?, one of which is situated near the coracoid process. 

The deltoid muscle raises the arm and separates it from the side of 
the body. 

§ 1110. A remarkable analogy with the structure of the mammalia 
is the existence of a posterior slip, entirely distinct from the rest of the 
muscle, which we have found several times. This slip arises from the 
tendinous expansion of the infraspinatus muscle (§ 1112), and from the 
centre of the inner edge of the scapula, by a broad and thin tendon, 
and is attached to the tendon of the deltoides. In most mammalia, in 
fact, the deltoides divides into a clavicular and a scapular portion and 
the latter is subdivided into an acromial and a spinous portion. 

We more frequently find the posterior part of the muscle simply 
separated from the anterior. We ought also to place among these 
anomalies the existence of a head, which goes from the anterior edge 
of the scapula to the deltoides,(l) and which is still more analogous 
with a part of the deltoides in birds. 

(1) Albinus, p. 422. 



116 DESCHIFTITE ANATOM1 



II. ROTATORS OUTWARDLY. 



I. SUPRAsriNATUS. 



§ 1111. The supraspinutus muscle, Fetit sus-scapulo-trochiterien, 
Ch., is a triangular muscle which fills the supraspinal fossa, and is 
formed of fibres which converge from behind forward, from below 
upward, and from within outward. At first it is rather thick, but gra- 
dually becomes thinner. It arises from all the supraspinal fossa, from 
that part of the posterior edge of the scapula situated above the spine, 
and from the posterior part of the upper edge and also from the up- 
per face of this spine. It changes under the acromion process, directly 
below the large proper ligaments of the scapula, into a short and strong 
tendon, which, passing below the capsular ligament of the scapulohu- 
meral articulation, which it contributes to strengthen, goes to attach 
itself to the upper and inner part of the outer tubercle of the humerus. 

This muscle turns the arm outward and raises it. 



II. INFRASPINATUS. 



§ 1112. The infraspinatus muscle, Grand sus-scapulo-trochiterien, 
Ch., arises from all the infraspinal fossa of the scapula, except its 
lower part. It goes outward and forward, so that its upper fibres are 
transverse, and the lower become more oblique forward and upward the 
lower they are. Its thickness gradually increases as it proceeds 
outwardly and it terminates in a strong tendon, which extends farther 
on the posterior than on the anterior face. This tendon adheres to the 
capsular ligament of the shoulder which it strengthens, blends above 
with that of the preceding muscle, and is attached to the central part 
of the outer tubercle of the humerus. 

We find a large mucous bursa between the scapula and this tendon. 

This muscle draws the humerus backward and downward, and 
rotates it from within outward. 



III. TERES MIUOR. 



§ 1113. The teres minor muscle, Plus petit sus-scapulo-trochiterien, 

Ch. is quadrangular, and is scarcely distinguished from the preceding. 
It arises from the central part of the posterior lip of the anterior edge 
of the scapula, and goes directly before the lower and anterior edge of 
the infraspinatus muscle forward, outward, and downward, where, 
gradually becoming narrower but thicker, it terminates b} r a short and 
strong tendon at the lower part of the outer tubercle of the humerus, 
and at the outer ridge of the humerus which descends from this tu- 
bercle. 

It acts like the preceding, but it draws the humerus more outward 



MYOLOGY. 117 

III. ROTATORS INWARD. 

SCB-SCAPULAHIS. 

§ 1114. The subscapularis muscle, sous-scapulo-trochinien, Ch., the 
strongest of the two muscles which turns the humerus on its axis 
inward, occupies all the lower face of the scapula. Its upper fibres 
descend obliquely outward and forward, the central are transverse, and 
the inferior are very oblique from behind forward and from within 
outward. It gradually contracts to a considerable degree, passes 
behind the upper end of the coraco-brachialis, and the short head of 
the biceps muscle, and terminates in a short, fiat, and thick tendon, 
which is attached to all the circumference of the inner tubercle of the 
humerus. 

Its structure is very complex, and we may reduce it to two orders of 
fasciculi which are more or less evidently distinct. The first, com- 
monly five in number, arise by a tendinous summit along the inner lip 
of the posterior edge, and the asperities which are found on the ante- 
rior face of the scapula. The lower, which is also the strongest, forms 
the lower and outer part of the muscle. All progressively enlarge, 
and are attached to the upper tendon. 

We find the second layer between them ; this also is formed of five 
fasciculi, of which the tipper likewise forms the upper part of the mus- 
cle. These fasciculi are generally stronger and broader externally, 
and pointed inwardly. They come from the spaces between the emi- 
nences, whence the former arise. 

These two layers however interlace more than once, and we cannot 
insulate them without cutting their fibres. The third layer, which is 
described in most works on anatomy, does not in fact exist. 

This muscle has two mucous bursae. The larger is sometimes 
united with the capsular ligament of the scapulo-humeral articulation, 
and is situated on the neck, and at the base of the coracoid process of 
the scapula. The smaller, which does not always exist, is situated 
much lower and further forward, between the capsular ligament and 
the tendon of the muscle. 

The subscapularis muscle draws the arm towards the trunk, turns 
it on its axis from without inward, and depresses it when it is 
raised. If the arm is fixed it can carry the scapula outward. 

II. TERES MAJOR. 

§ 1115. The teres major muscle, Scapulo-humeral, Ch. (JVf. teres, s. 
rotundus major, s. deprimcns humerum rotundus) arises from the lower 
and triangular part of the outer face of the scapula, and from the pos- 
terior lip of the anterior edge, where it usually adheres to the subscapu- 
laris and teres minor muscles ; but it soon leaves these two muscles and 
ascends, always much less obliquely than the teres minor, from which 



118 DESCRIPTIVE ANVTOMV. 

it is separated by the long portion of the biceps, between the latter and 
the coraco-brachialis, approximates the humerus, and is attached by 
rather a short, broad, but thin tendon, to the inner rough line, directly 
behind and a little below the latissimus dorsi. 

Its form is the same as that of the teres minor, but it is at least twice 
as large as that muscle. 

We find below and forward, between its tendon, the latissimus dorsi 
muscle, and the humerus, a small mucous bursa, and beside these, we 
also find one or more in its anterior tendon where it. divides. 

This muscle draws the humerus backward, downward, and inward; 
when the arm is turned outward, it brings it a little inward. 

§ 1116. It is often united with the posterior part of the latissimus 
dorsi muscle by a large fasciculus which leaves its posterior extremity. 

IV. COBACO BRACHIALIS. 

§ 1117. The coraco-brachialis muscle, Coraco-humcral, Ch. (M. 
coraco-brachialis, s. coracoideus, s. perforatus Casserii) is formed like 
an oblong triangle. United above, rather intimately, and to some 
extent, to the origin of the short portion of the biceps flexor muscle 
(§ 1120), it arises from the coracoid process farther forward than the 
latter. It is tendinous before, in most of its length, and fleshy behind. 
In quitting the short portion of the biceps muscle it goes inward, 
becomes thicker at its central part, but contracts much at its lower 
end, and is attached, partly fleshy, partly tendinous, to the middle 
region of the inner face of the humerus. 

The musculo-cutaneous nerve generally perforates it in its centre. 
Its lower part often blends with the upper end of the brachialis internus 
muscle, a curious fact, as it adds a new feature to the analogy between 
the flexors of the fore-arm and those of the leg. We find one imper- 
fect bursa, and sometimes two, between its upper tendon, that of the 
short portion of the biceps muscle, and the capsular ligament of the 
scapulo-humer al articulation . 

This muscle approximates the humerus and the scapula to each 
other, carries the arm to the side of the body, and rolls it a little out- 
ward, when it is turned inward. 

Sometimes, instead of a simple perforation, it presents a real fissure, 
which is often confined to its lower part, and sometimes exists its 
whole length, so that the tendons are separated although the musculo- 
cutaneous nerve passes constantly between the two portions. This 
arrangement establishes a striking similarity with the structure of the 
apes. 



MYOLOGY. 119 

ARTICLE THIRD. 

MUSCLES OF THE ARM. 

§ 1118. The muscles found on the humerus arise partly from this; 
bpne, others from the scapula, and are attached to the bones of the 
fore-arm. They are the triceps extensor, the biceps flexor, and the brachi- 
alis internus ; the first is situated at the posterior and outer part of the 
arm ; the other two are placed on its anterior and inner face. 

I. TRICEPS EXTENSOR, 

§ 1119. The triceps extensor muscle, Scapulo-olecranien, Ch. (JVf, 
triceps brachii, cubiti, s. brachieus externus, s. posterior) occupies most 
of the posterior face of the humerus, and extends from the scapula to 
the olecranon process. 

The long or the posterior head {caput longum, anconceus longus) 
arises by a short, flat, and thick tendon, directly before the anterior 
insertion of the teres minor muscle, from the upper end of the anterior 
edge of the scapula, and goes from above downward, gradually increas- 
ing in thickness. The tendon descends very low on its inner face. Its 
lower tendon extends in all its lower half along the inner part of its 
inner face, and the fleshy fibres are inserted in it obliquely. Its form 
is elongated. 

The large head, or the outer head, (caput externum, s. magnum, an- 
conceus magnus, s. externus) arises above by a thin extremity which 
terminates by a convex edge, and presents very short tendinous fibres. 
This end is attached, directly below the insertion of the teres minor 
muscle, at the upper part of the posterior face of the humerus. The 
fleshy fibres come also from all the anterior edge of the bone. This 
head descends as far as the outer condyle, by a short tendon, which is 
oblique from above downward, from before backward, and from with- 
out inward, unites backward and inward to the lower tendon of the 
long head. In all its lower portion its inner and posterior part is 
covered by the common lower tendon of the brachialis internus muscle. 
Its form is that of an elongated rhomboid, its breadth exceeds its thick- 
ness. 

The short or internal head arises, directly below the upper extremity 
of the preceding, from most of the posterior face of the humerus, and 
descends along the inner edge of the bone to near the inner condyle, 
rests, by its posterior and inner edge, upon the tendons of the teres 
major and coraco-brachialis muscles, and also the inner edge of the 
brachialis internus. Its fibres go obliquely downward and outward ; 
they are attached to the lower tendon of the long head in all the lower 
part of the short head. 



120 DESCRIPTIVE ANATOMY. 

The common lower tendon of these three heads, which covers them 
outwardly at then lower part, is not destitute of fleshy fibres except in 
a very small portion of its extent below, and is inserted in the upper 
broad edge of the posterior face of the olecranon process of the ulna. 

We find a considerable mucous bursa between this tendon and ihe 
olecranon process, besides which we sometimes find two smaller ones 
on each side. We less commonly see another, also smaller, above. 

This muscle extends the articulation of the elbow and usually moves 
the fore-arm ; but it can also move the arm when the fore-arm is fixed. 
The long head brings the scapula towards the humerus, and draws 
the latter inward and backward. 



II. BICEPS FLEXOR. 

§ 1120. The biceps flexor muscle, Scapido-radial, Ch. (flexor 
ant: brachii biceps, s. radialis, s. biceps interims), is a very long muscle, 
situated on the anterior and the outside of the arm, and extends its 
whole length. Its two heads are separated above in almost all the 
muscle, and extend from the scapula, whence they arise, to the upper 
extremity of the radius. 

The internal, posterior, or short head (caput breve), called also the 
coraco-brachialis muscle, from one of its attachments, is not only shoiter 
but also thinner than the long head. It arises from the coracoid pro- 
cess by a short, flat, and narrow tendon, which it has in common with 
the coraco-brachialis muscle, more forward and outward than the latter, 
proceeds on its outside a little obliquely from within outward, covers 
below the inner and upper part of the brachialis internus muscle, and 
lower down becomes a tendon, which is first seen on its external face, 
on the side corresponding to the long head. This tendon, which unites 
to that of the last, is attached to the tuberosity of the radius. 

The long head (caput longum, s. JYI. gleno-radialis) arises by a long, 
thin, and flat tendon from the centre of the upper part of the edge of the 
glenoid cavity of the scapula. This tendon is inclosed in a special 
fold of the capsule of the scapulo-humeral articulation, which answers 
as a mucous sheath, passes upon the head of the humerus, and is situ- 
ated in the groove between the two tuberosities of this bone, where it 
is retained by the fibres of the fibrous ligament of the shoulder-joint, 
and on the anterior extremity of which the mucous sheath ceases. It 
thus comes to the anterior «i.nd outer side of the arm, where it soon con- 
tinues with its fleshy belly but deeper than the tendon of the short head. 
This latter descends above, along the anterior and external edge of the 
triceps extensor muscle ; below, before the central part of .the bra- 
chialis internus muscle : at its lower extremity it is attached" on one 
side, that is by its internal face, to the tendon of the short head ; on 
the other to a peculiar tendon contained within it, and which v/hen en- 
tirely destitute of fleshy fibres is united with that of the first head, be- 
ing inserted at the same place with it. 



MYOLOGY. 121 

We find a large mucous bursa between the lower tendon, that of the 
supinator brevis and the tuberosity of the radius, to which sometimes a 
smaller is added, situated on the outer face of the tendon. 

The principal use of this muscle is to flex the articulation of the 
elbow. It also turns the fore-arm backward, contributes to draw it 
inward when it is extended, and depresses the scapula toward the 
humerus. 

§ 1121. The biceps flexor muscle is one of those muscles most 
subject to variation, and presents the most singular anomalies. 

The least considerable anomaly is where the two heads arise much 
lower than usual, so that they are only united by the inferior tendon.(l) 

A greater anomaly, which is not rare, is when a third head exists, 
which is usually smaller than the other two and which arises near the 
centre of the internal face of the humerus,(2) more rarely from only 
the brachialis internus muscle, (3) although it is often blended with it. 
Sometimes also it is united with the coraco-brachialis muscle. This ano- 
maly is very remarkable, as it is a repetition of the small head, which 
properly belongs to the biceps femoris muscle, and because its union 
with the coraco-brachialis muscle makes the number of the long flexors 
of the fore-arm equal to those of the long flexors of the leg. At the 
same time it approximates man to animals ; since in birds the long 
flexor of the fore-arm presents a second smaller head, which arises from 
the lower tuberosity of the humerus ; while in apes the brachialis 
internus muscle extends much higher. 

The number of heads of this muscle sometimes increases still more, 
so that we number five ; but these are not inserted in one common 
inferior tendon. (4) At the side of the third which is most usually met 
with we sometimes find a fourth, and along the tendon of the short head 
a fifth, which unite and are attached to the radius below the usual 
tendon ; in this case, consequently, there were in fact three flexors, as 
is always found in birds. 

III. BRACHIALIS INTERNUS. 

§ 1122. The brachialis internus muscle, Humero-cubital, Ch. (M. 
flexor cubitalis ulnaris, s. brachieus internus), a broader and thicker 
muscle, especially at its posterior part, which entirely covers the infe- 
rior portion of the internal and anterior faces of the humerus, arises by 
an external and an internal slip, the former being higher, from the ex- 
ternal and internal faces of the humerus above its centre. These 
two slips surround the lower extremity of the deltoidcs muscle ; the 
internal extends to the coraco-brachialis and the external to the upper 

(1) Weitbrecht, Comment. Pctrop., 1731.— Albinus, loc. cit.— Rudolphi, in Gantzcr, 
6. — We have seen it several times but always on one side. 

(2) Albinus, loc. cit., p. 438, 439.— Mayer, loc. cit. 

(3) Kelch, loc. cit., p. 35. 

(4) Pietsch, in Roux Journal de Med., vol. xxxi. p. 245. 

Vol. II. 16 



122 DESCRIPTIVE ANATOMY. 

extremity of the large head of the triceps extensor muscle. Its ante- 
rior edge descends along the external edge of the humerus, and the 
posterior along the internal edge of this bone to the part where it sud- 
denly enlarges. 

Its fibres are attached to a strong rounded inferior tendon, which re- 
ascends on the anterior face of the muscle almost to its centre. This 
tendon is inserted in the tuberosity of the ulna. 

Between the tendon of the brachialis internus, that of the biceps 
flexor cubiti, the supinator brevis muscle, and the capsular ligament, 
we find a mucous bursa, which is not however constant. 

This muscle flexes the articulation of the elbow. 

§ 1123. We sometimes find at the side of it, but more forward and 
outward, a second brachialis internus muscle, which is smaller and 
which is an exact repetition of it as respects its attachments, the inferior 
tendon of which is inserted deeper than that of the other, and which 
even presents a rudiment of the preceding muscle, which we said be- 
longed to birds. The first degree of this anomaly is the separation of 
the posterior from the anterior part of the muscle, which not unfrc- 
quently occurs. This division of the brachialis internus muscle into 
two parts is also worthy of remark, as it assimilates this muscle to the 
flexors of the leg. Its abnormal union with the biceps flexor by a mus- 
cular slip (§ 1121) is on the contrary the first index of the formation of 
a third head to the latter (§ 1121). 

The anomalies of the brachialis internus, the biceps flexor, and the 
coraco-brachialis muscles (§ 1116), considered collectively, seem to be 
so many efforts by which nature endeavors to establish a perfect resem- 
blance between the upper and lower extremities. They are generally 
found singly ; but if we suppose them united, we have an arrangement 
perfectly similar to that of the lower extremities. 

The coraco-brachialis and brachialis internus muscles, divided into 
two portions and often united with each other, evidently represent the 
semimembranosus and the semitendinosus muscles. The muscular band 
which goes from the brachialis intermis to the lower part of the biceps 
flexor muscle, united with the unusually deep division of the latter, may 
be considered as tending to insulate the two heads and to form a second 
flexor of the ulna, even as the tibia is flexed by two distinct muscles. 



ARTICLE FOURTH. 

MUSCLES OF THE FORE-ARM. 

§ 1124. The muscular mass of the fore-arm is formed of those mus- 
cles which move the bones upon each other or on the humerus, by the 
muscles which act on the carpus, and by the long muscles of the fingers. 

The motions of the bones of the fore-arm on each other, or pronation 
and supination, are performed by four muscles, the supinator longus 



MYOLOGY. 123 

and the supinator brevis, the pronator teres and the pronator quadratus, 
all of which except the first are situated deeper than the other muscles 
of the fore-arm. 

The two bones of the fore-arm are moved on the humerus by one 
muscle, the anconeus. 

Five muscles move the carpus ; the extensor carpi radialis longus 
and the extensor carpi radialis brevis extend it ; it is flexed by the 
flexor carpi ulnaris and the flexor carpi radialis muscles ; the extensor 
carpi ulnaris draws it backward. 

The fingers are extended by the extensor digitorum communis, the 
extensor pollicis longus and brevis, the extensor indicis proprius, and the 
extensor minimi digiti proprius ; they are flexed by the flexor sublimis, 
the flexor profundus, and the flexor pollicis longus. 

These different muscles succeed each other in the following order, 
when we commence their description at the radial edge and follow 
the external face of the fore-arm to the ulnar edge and return from this 
to the radial edge along the internal face of the arm. 

I. MUSCLES OF THE INTERNAL FACE OF THE FORE-ARM. 
I. SUPINATOR LONGUS. 

§ 1125. The supinator longus muscle, Humero-sus-radial,Ch. ^isa. long 
muscle, which arises by short tendinous fibres from the inferior part of the 
anterior edge of the humerus, where it unites with the large head of the 
triceps extensor muscle. It goes downward and passes on the inferior 
and external part of the brachialis interims, which it covers, and 
reaches the fore-arm along and before the inferior extremity of this 
muscle ; it goes on the radial edge of the fore-arm and is changed high 
up into a long and thin tendon, which covers above only the internal 
face, and is finally attached to the anterior face of the internal edge of 
the radius, a short distance above its inferior face. It turns the radius 
backward and inward, consequently carries the hand to the state of 
supination, and flexes the fore-arm. 

II. EXTENSOR CARPI RADIALIS LONGUS. 

§ 1126. The extensor carpi radialis longus muscle, Humero-sus- 
metacarpien, Ch., resembles the preceding and appears at first view to 
be a part of it. It arises from the lowest part of the outer edge of the 
humerus, descends to the outer condyle, passes on the outer part of the 
articular edge of the humerus, and on the head of the radius ; in its 
course it becomes first thicker, afterward narrower, and terminates at 
the same place as the preceding in a tendon, at first rather broad, flat- 
tened, and loose to a much greater distance, which descends in the same 
direction along the radius and enters below into the anterior groove of 
the outer face of the lower extremity of the radius under the posterior 
ligament of the carpus, thus arrives at the. carpus and is attached to 



124 DESCRIPTIVE ANATOMY 

the anterior part of the posterior face of the base of the second metacar- 
pal bone. 

The lower tendon is surrounded with a mucous sheath where it 
passes over the lower extremity of the radius. We also find a small 
bursa at its insertion in the root of the second metacarpal bone. 

This muscle extends the hand and draws it a little toward the radial 
side of the fore-arm ; it also serves to execute the motion of pronation 
to a certain extent and flexes the articulation of the elbow. 

§ 1127. Sometimes a smaller and feebler muscle is detached from 
its lower edge, which succeeds the extensor carpi radialis brevis mus- 
cle and is attached a little above it to the root of the third metacarpal 
bone.(l) 

III. EXTENSOR CARPI RADIALIS BEEVIS. 

§1128. The extensor carpi radialis brevis muscle, Epicondylo-sus- 
metacarpien, Ch., is very similar to the preceding, but is smaller. Its 
upper tendon, which is very strong, exists nearly the whole length of 
its posterior face. It arises from the anterior face of the outer condyle 
of the humerus, and is attached, below the middle of the fore-arm, by 
an elongated, fiat, but narrow tendon, the upper part of which covers the 
lower part of the outside of the muscle. This tendon is inserted in the 
outer face of the base of the third metacarpal bone, and slightly also 
in that of the second. There is a small bursa between it and the third 
metacarpal bone. 

This muscle acts in the same manner as the preceding. 

§ 1129. It is sometimes entirely deficient,(2) as in several mammalia, 
where we never find but one extensor radialis muscle : the first degree 
of this formation is the complete union of the second radialis muscle, of 
which several instances are known. Sometimes its tendon divides into 
two slips, which are attached to the third metacarpal bone only, or one 
is inserted into this bone, and the other into the next ; even as in the 
mammalia, which have only one radialis muscle, the tendon divides 
into two slips. 

Besides the bursae already mentioned, the tendons of the two muscles 
are surrounded by two common sheaths, the upper of which is situated 
above the lower end of the radius, while the lower is placed at a short 
distance from it on this extremity, and on the upper range of the carpal 
bones. 

IV. EXTENSOR DIG1TOHUM COMMUNIS. 

§ 1130. The extensor digitorum communis muscle, Epicondyh-sus- 
phalangettien commun, Ch., commences by a strong tendon, which 

(1) Albinus, loc. cit., p. 448. 

(2) J. G. Salzmann, Diss. sist. plurium pedis musculorum defectum. Strasburer, 
1734, p. 11. b 



MYOLOGY. 125 

extends on the upper part of the external face of its belly. It arises 
from the lower and back part of the outer condyle of the humerus, 
directly under and behind the radialis externus brevis muscle, with 
which it is intimately connected for several inches. Near the centre 
of the fore-arm it separates into three bellies, the posterior of which 
also divides a little farther in two others, so that the whole number of 
these bellies is four ; these are inserted into as many elongated and 
flat tendons, of which the second is usually the strongest, the third 
smaller than the first, and the fourth is the weakest. 

All these tendons pass under the posterior ligament of the carpus, 
between it and the outer face of the lower end of the radius. They 
become broader and thinner on the back of the hand, partially separate, 
especially near the anterior end of the metacarpus, and are again united 
by strong oblique intermediate tendons of various breadths. They go 
to the second, third, fourth and fifth fingers, and contract on the articu- 
lation of the metacarpus with the phalanges ; but in this place they 
give off on each side fibres, which go downward ; farther on they 
again enlarge, and are blended on each side with the tendons of the 
interosseous muscles. On the first joint of the phalanges they divide 
into a central and two lateral portions, which are much longer ; the 
central tendon, having strengthened the dorsal face of the capsular 
ligament, is attached to the upper edge of the base of the second pha- 
lanx ; the other two are united forward, and are inserted in the upper 
part of the back of the third phalanx. 

At the lower end of the fore-arm, of the carpus and metacarpus, the 
tendons of this muscle have a mucous sheath, which is single above, 
but divides on the carpus into three branches, each of which goes with 
its tendon to the base of the first phalanx. 

This muscle extends the second, third, fourth, and usually the fifth 
finger also. 

§ 1131. Sometimes its three bellies are separated high up, and even at 
their original ) Sometimes it divides into four tendons ; the fourth goes 
to the little finger, and unites to its proper extensor. This fourth tendon 
sometimes divides on the back of the hand into two parts ; the outer 
joins the tendon of the extensor minimi digiti proprius muscle, and the 
inner again divides into two portions, one of which unites to the tendon 
of the fourth finger, and the other to that of the fifth. (2) In some sub- 
jects the third and fourth tendons go to the third finger. In this case 
the muscle itself often divides into two bellies, each of which has two 
tendons. (3) 

These divisions of the fleshy part of the muscle are curious, being 
similar in one respect to the extensors of the toes and also to the flexors 
of the fingers, which are both double. 

(1) Albinus, loc. cit., p. 452.— Brugnone, loc. cit., p. 167. 

(2) Albinus, loc. cit. 

(3) Brug-none, loc. cit. 



126 DESCRIPTIVE ANATOMT. 



V. EXTENSOE MINIMI DIGITI PBOPBIUS. 



§ 1132. The extensor minimi digiti propriw muscle, Epicondylo- 
sus-phalangetiien du petit doigt, Ch., is slender, elongated, and thin. 

It arises by two tendinous heads from the outer part of the head of the 
radius, from the part of the capsular ligament surrounding this head, 
and from the upper end of the anterior edge of the ulna. It descends 
behind the preceding, with which it is closely united for some distance, 
and near the lower end of the fore-arm becomes a thin tendon, which 
passes below the posterior ligament of the carpus in a special groove, 
enlarges along the metacarpal bone of the fifth finger, unites inward with 
the fourth tendon of the preceding muscle, and is attached to the upper 
face of the head of the third phalanx of the little finger. 

Its tendon is surrounded from the lower part of the fore-arm to the 
centre of the fifth metacarpal bone by a sheath, which is single above, 
but below divides like the tendon into two parts. 

This muscle extends the little finger. 

§ 1133. It is sometimes deficient, (1) and then it is generally 
replaced by a tendon of the extensor digitorum communis muscle. In 
other cases, on the contrary, its tendon divides into two slips, one of 
which goes to the fourth finger, an arrangement worthy of remark 
because of its analogy with several mammalia. 



VI. EXTENSOR CARPI ULNARIS. 



§ 1134. The extensor carpi ulnaris muscle, Cubito-sus-melacarpien, 
Ch. (J\I. ulnaris extermis, s. extensor manus ulnaris), arises by two ten- 
dinous slips, of which the smaller and shorter is situated at the side of 
the extensor digitorum communis, and comes from the posterior and 
lower part of the external condyle of the humerus, and the longer 
arises from the upper part of the anterior face of the tubercle of the 
ulna. These two slips soon unite in a considerable belly. The latter 
is tendinous at its inner and outer faces, and adheres in a considerable 
extent to the extensor proprius minimi digiti muscle, descends along 
the outer face of the ulna, from which it receives some fibres, and be- 
comes, near the lower third of the fore-arm, a strong tendon, which, 
passing across a particular portion of the dorsal ligament of the carpus, 
comes on the back of the hand, where it is attached to the tubercle of 
the metacarpal bone of the fifth finger. There is but one mucous 
bursa between its upper extremity and the head of the radius. 

This muscle extends the hand and draws it backward toward the 
posterior edge of the fore -arm. 

§ 1135. A tendon of greater or less extent is often detached to go to 
the fifth finger, and at the base of the first phalanx unites with that of 
its proper extensor. 

(1) Brugnone, p. 167. — We have known two instances where it was deficient. 



MYOLOGY. 127 



VII. ANCONEUS. 



§ 11.36. The anconams muscle, Epicondylo-cubilal, Ch. (JVf. anco- 
neus, s. anconeus quartus), is a triangular muscle and mostly covered 
by the upper extremity of the preceding ; it arises by a short and strong 
tendon from the inner part of the outer condyle of the humerus, descends 
toward the ulna, and is attached by a broad fleshy surface to the 
upper part of the anterior face of this bone. Its upper straight edge 
usually blends with the outer belly of the triceps extensor muscle. 

This muscle extends the fore-arm, also turns the radius backward, 
so that it assists in supination. 



VIII. SUPINATOR BEEVIS. 



§ 1137. The supinator brevis muscle, Eqricondijlo-radial, Ch., is tri- 
angular ; its base looks upward, and its apex downward. It arises 
from the upper part of the anterior face of the ulna, and is tendinous 
outwardly and fleshy inwardly. Its upper fibres are transverse and 
the lower oblique. It goes downward and forward, turns on the upper 
part of the radius, and is attached by a broad fleshy edge to the ante- 
rior part of the capsule of the ulna, and also to the upper part of the 
anterior and inner faces of the radius as far as its posterior edge. It 
turns the hand and the radius on their axes backward and outward. 

§ 1138. The upper part of this muscle often separates from the 
lower sooner than usual, and differs from it in the direction of its fibres, 
is separated from it by the radial nerve, and is attached to the radius 
without being connected with it. This anomaly leads to that in which 
two small supinator muscles exist ; the upper extending from the 
outer condyle of the humerus to the anterior edge of the upper end of 
the radius, while the internal goes from the head of the radius to its 
centre.(l) Probably the second variety may be considered as an 
index of the formation peculiar to apes, in which three supinators 
exist.(2) 

IX. ABDUCTOH POLLICIS LONOUS. 

§1139. The abductor pollicis longus muscle, Cubilo-sus-m6ta- 
carpien du pouce, Ch., is a considerable muscle inserted, by very short 
tendinous fibres, directly below the anconeus and the supinator brevis, to 
the second fifth of the anterior edge of the ulna, to the outer face of the 
interosseous ligament, and to the central part of the outer face of the 
radius. It descends along the last, passes below on the anterior face of 
the radius, and there becomes a strong tendon, which passes through 
a particular division of the dorsal ligament of the carpus. This tendon 

(1) Sandifort, Hist.rmtsc. p. 93— Brugnone, loc.cit. p. 163. 

(2) We have found at least in the Simia apclla two long supinators, situated at the 
side of each other. 



128 DESCRIPTIVE ANATOMY. 

generally divides into two or three slips : the strongest, which is also 
the most anterior, is attached to the radial edge of the base of the first 
metacarpal bone ; the other two blend with the posterior extremity of 
the antagonist muscle of the thumb. 

The tendon near its upper extremity is surrounded by a large, oblong, 
and rounded mucous sheath. 

This muscle separates the thumb from the fingers, and moves ii 
toward the radius. 

§ 1140. It is often more or less divided into two bellies, each of 
which terminates by a tendon, and the lower is usually larger than the 
upper. The tendons of these two bellies arc often divided, and some- 
times unite ; sometimes they are attached to the first bone of the meta- 
carpus and to the trapezium.(l) 

We more rarely find a digastric abductor of the thumb, which arises 
from the outer condyle of the humerus, and is inserted into the base of 
the first phalanx of the thumb. 

X. EXTENSOR »OLLICIS BREVIS. 

§ 1141. The extensor pollicis brevis muscle, Cubitosus-phalangien 

du jmuce, Ch.. is a very small muscle, situated below the preceding, 
and adheres intimately to its inferior edge. It arises from the outer 
face of the interosseous ligament and from the radius, and becomes a 
very thin tendon, which passes through the dorsal ligament of the 
carpus in the same groove with the abductor pollicis longus, then goes 
on the back of its metacarpal bone, becomes broader, and is attached 
to the centre of the upper edge of the base of its first phalanx. 

This muscle extends the thumb, and at the same time removes it 
from the other fingers. 

§ 1 142. A small tendon sometimes arises from the anterior extremity 
of its tendon, which blends with that of the next muscle. 

Sometimes this muscle does not exist as a distinct muscle, and forms 
only the lower part of the abductor pollicis longus muscle. 

XI. EXTENSOR POLLICIS LONGUS. 

§ 1143. The extensor pollicis longus muscle, Cubilo-sus-phalangcl- 
tien du poucc, Ch. (M. extensor pollicis major s. longus), is much 
stronger than the preceding, and covers its upper part ; it arises, a little 
below the abductor magnus, and directly below its upper extremity, 
above from the outer face and below from the anterior edge of the 
ulna, and from the adjacent part of the external face of the interosseous 
ligament. It soon becomes a long tendon, which passes through the 
second groove of the dorsal ligament of the carpus, goes forward at the 
side of the preceding, but much more inwardly, partially covers it, and 

(1) Flcischmann, in the Erlangcr Abhand., vol. i. p. 28. 



MYOLOGY. 129 

is attached to the base of the second phalanx of the thumb, in the same 
manner as the tendon of the extensor digitorum communis is ; but it 
does not divide. 

Its tendon has two mucous sheaths : the upper and larger is situ- 
ated at the lower part of the fore-arm, and extends to the carpus ; the 
inferior is smaller, and is placed on the carpus and on the base of the 
first metacarpal bone. 

It extends the thumb, and brings it a little towards the other fingers. 

§ 1144. Sometimes it is completely double. 

XII. EXTENSOR INDICIS PROPRIUS. 

§ 1145. The extensor proprius indicis muscle, Cubito-sus-phalanget- 
tien de Vindex, Ch. (M. indicator, s. indicatorius, s. indicis extensor, s. 
abductor), is nearly as large as the preceding. It arises directly below 
it by two slips from the third quarter of the anterior face of the ulna, 
and near the lower part of the fore-arm becomes a strong tendon, 
which, covered by that of the extensor digitorum communis, passes 
with it through the third division of the dorsal ligament of the carpus, 
below the tendinous band which goes from the latter muscle to the 
indicator finger ; it proceeds more inwardly than this band, and is 
attached to the base of the first phalanx of the finger, blending with it. 

It extends the indicator finger, and approximates it a little towards 
the third. 

§ 1146. Sometimes it is digastric, and interrupted in its course by a 
long tendon.(l) 

This muscle presents several anomalies which are exceedingly 
interesting: they consist in its more or less perfect multiplication and 
in the formation of the extensor pollicis tertii proprius. 

The lowest degree of this anomaly is the division of its portion into 
two slips both of which go to the second finger,(2) or the division of 
its belly into two parts, the tendons of which unite before arriving at 
this finger,(3) or finally the existence of two bellies of the usual size, 
which are entirely distinct, and of which one arises from the radius. (4) 

The most complete anomaly is when one of the slips of the tendon 
does not go to the indicator, but to the middle finger. (5) 

Sometimes a small and perfectly distinct muscle arises from the 
lower part of the outer face of the radius and from the dorsal ligament 
of the carpus, and is attached to the first phalanx of the indicator.(6) 
This variety is only a more perfect development of the case in which 
the muscle arises by two heads. 

Next comes the anomaly where we find a proper extensor of the 
middle finger ; this muscle is always smaller than the extensor indicis 



(1) Rosenrnuller, loc. cit., p. 6. 

(2) We have seen it several times. 

(3) Albinus, p. 458. — Heymann, p. 13. 

(4) Gantzer, p. 14. 

(5) Albinus, p. 468. — Peitsch, Syllogc obs. anat. 

(6) Albinus, Ann. acad., vol. iv. ch. vi.— Heymann, p. 12. 
Vol. II 17 



130 BE8CRirXlVB ANATOMY. 

propnus, and arises more or less below and under it. This formation 
varies the least possible from the normal state when the new muscle 
comes from the ulna;(l) but sometimes it arises from the radius(2) 
or from the dorsal ligament of the carpus.(3) 

The o- r eatest anomaly is where we find, beside the extensor indicis 
proprius°an extensor for the middle finger, which divides into two ten- 
dons, one of which is attached to the metacarpal bone of the index 
finger, and the other to that of the middle finger. 

Finally, we have seen in one case a small tendon, which extended 
from this 'proper extensor of the middle finger to the base of the first 
phalanx of the index finger. 

All these anomalies are curious in two respects : 1st, as a repetition 
of the normal formation of the lower extremities, since they represent 
the extensor communis digitorum brevis, and that more perfectly as the 
supernumerary muscles arise lower ; 2d, as analogous with animals ; 
for in many apes the tendon of the extensor indicis proprius furnishes a 
slip to the middle finger, and in others, for instance in the shnia apella, 
we find a proper extensor of the index finger. (4) 

II. MUSCLES OF THE INTERNAL FACE OF THE FORE-ARM. 

I. PALMARIS LONGUS AND BEEVIS AND THE PALMAH APONEUROSIS. 

§ 1147. The palmaris longus muscle, Epilrochlo-palmaire, Ch., 
is a thin oblong muscle, which arises, directly below the preceding and 
farther back, than it, from the upper part of the anterior face of the 
inner condyle of the humerus. It goes directly forward and downward, 
and becomes in the middle of the fore-arm a broad and thin tendon, 
which is very near the skin. This tendon however is covered by the 
anti-brachial aponeurosis in most of its length, and passes over this 
aponeurosis only at its lower part. At its lower end, it divides into 
two fasciculi : the anterior, which is shorter, and which is attached to 
the posterior end of the abductor pollicis ; and the posterior, which is 
much larger, and is called the palmar aponeurosis {aponeurosis pal- 
maris). This aponeurosis is thinner than the tendon, but much 
broader and triangular. It gradually enlarges from behind forward, 
so that it corresponds by its anterior edge to the four fingers. It how- 
ever becomes thin, and its fibres occasionally have intervals between 
them. 

It is composed essentially of longitudinal fibres, like the tendon of 
which it is the expansion. Its anterior edge is however formed of 
transverse fibres, which are arranged over the preceding. 

It covers most of the muscles of the palm of the hand, except those 
of the thumb and the little finger. 

(1) We have seen it several times. 

(2) We have seen it once. 

(3) Brugnone, loc. cit., p. I6S. 

(4) Meckel, Jieytragc zur verglciclundcn anatomic, vol. ii. p. 11. 



MYOLOGY. 131 

The palmaris brevis muscle, which is composed of transverse fibres, 
is attached to its internal edge at its upper part. This muscle, the 
internal edge of which comes from the skin, serves to tense the apo- 
neurosis outwardly. 

§ 1148. The palmaris longus muscle is often deficient ; sometimes 
it is replaced by a tendon of the flexor digitorum sublimis.(l) In other 
cases, on the contrary, it is unusually developed in fact thinner, but very 
broad, and descends almost into the palm of the hand. (2) This rudi- 
ment of a peculiar muscle, which sometimes extends from the coronoid 
process of the ulna to the palmar ligament of the carpus, is worthy of 
remark, especially as it forms an analogy with apes. (3) 

II. RADIALIS INTERNt'S. 

§ 1149. The radialis interims muscle, Epitrochlo-metacarpien, Ch. 
(M. radialis interims, s. flexor manna radialis), is much larger than 
the preceding, and is blended above with it, and on both sides with the 
pronator-teres and the flexor communis digitorum sublimis ; it comes 
from the anterior face of the inner condyle of the humerus, and some- 
times also by a small head from the radius. It is partly covered by 
the preceding and goes downward and a little forward, and near the 
middle of the fore-arm becomes a broad tendon. This tendon passes 
under the palmar ligament of the carpus in a special canal, formed by 
the palmar ligament, and by the os trapezium ; it is harder and thicker 
in this place than in other parts. After leaving this canal it becomes 
thinner but broader, and is attached partly to the os trapezium, but 
more particularly to the inner face of the second metacarpal bone. 

We find a mucous bursa between the lower end of the tendon, the 
os trapezium, and the proper palmar ligament. 

This muscle flexes the hand and carries it a little forward. 

III. PRONATOR TERES. 

§ 1 150. The pronator teres muscle, Epitrochlo-radial, Ch., a shorter 
but stronger muscle, arises by very short tendinous fibres from the 
upper edge and the upper part of the anterior face of the inner condyle 
of the humerus. It swells a little below its origin, goes obliquely 
downward and forward, and is covered at its lower part and at its upper 
edge by a strong tendinous expansion, and is attached by means of 
this, below the supinator brevis, and before the abductor pollicis longus, 
to the anterior face and outer edge of the radius, a little above its centre. 

It turns the radius and also the hand inward, forward, and down- 
ward. 

(1) Rosenmiiller p. 6. 

(2) Albiaus, p. 474. 

(3) Perrault, Mew. in Va/ruthu Tkeatr. root. p. 151.— Vicq. d'Azyr , Enrijrl 
vieth., nect.anat., vol. ii. p. 25, 257. 



132 DESCRIPTIVE ANATOMY. 

§ 1151. It is sometimes double. In this case the supernumerary 
muscle extends from the posterior edge of the ulna to the posterior edge 
of the normal muscle, which is an analogy with apes. 

IV. FLEXOR ULNARIS. 

§ 1152. The flexor ulnaris muscle, Cubilo-carpien, Ch. (M. ulnaris 
internus, s. flexor ulnaris), arises by two rather short heads, of which 
the upper comes from the lower part of the inner face of the inner con- 
dyle of the humerus, and the posterior or the inferior from the inner face 
of the olecranon process of the ulna. It descends along the ulna, from 
which it is always separated by the flexor digitorum communis, and be- 
comes a strong tendon at the lower end of the fore-arm which is attach- 
ed to the pisiform bone ; we find a very loose mucous bursa between 
it and this bone. 

It flexes the hand and inclines it toward the ulna. 

V. FLEXOR DIGITORUM COMMUNIS SUBLIM1S. 

§ 1153. The flexor digitorum communis sublimis muscle, Epitrochlo- 
phalanginien commun, Ch. (JM. flexor digitorum communis sublimis, s. 
perforatus), arises below the four preceding, by a much larger head, 
from the lower part of the anterior face of the inner condyle of the 
humerus, from the inner part of the capsular ligament of the elbow 
joint, and from the inner face of the coronoid process of the ulna ; it 
also arises by a small slip from the inner face of the radius at the lower 
end of the supinator brevis muscle. Long before this slip has joined 
the upper head, it divides into three bellies, of which the internal and 
posterior divide still lower into two others. Each of these bellies 
becomes a tendon, which all pass under the special palmar ligament 
of the carpus to arrive at the palm of the hand. 

Nearly opposite the centre of the first phalanx each tendon divides 
into two slips which unite farther on the second phalanx, so that their 
inner fibres interlace and again separate below this point to attach 
themselves behind the middle of the second phalanx to its radial and 
ulnar edges. 

These tendons are surrounded by a common sheath, near the lower 
extremity of the fore-arm, which, when arrived at the carpus, divides 
into several sacs, each of which goes with one of them to the base of 
the first phalanx. This muscle flexes the second phalanx of the 
fingers. 

§ 1154. One of the tendons, particularly that of the little finger, is 
sometimes deficient ; it is then replaced by one of the tendons of the 
flexor profundus muscle ; sometimes a belly of this muscle, especially 
that which belongs to the index finger, is entirely separated from the 
others, and divided besides into two fleshy portions by a long central 
tendon. As the anomaly is seen more commonly in the belly of the 
indicator finger, it is worthy of remark, from its analogy with the outer 



DB8CRIPTIVE ANATOMT. 133 

face of the fore-arm, since it represents the proper extensor of the index 
finger, and more, as the latter is also digastric in some subjects. 

VI. FLEXOR DIGITORUM PROFUNDUS. 

§ 1155. The flexor digitorum profundus muscle, Cuhito-phalanget- 
tien commun, Ch. {M. flexor digitorum communis profundus, s. suadus 
perforans), is stronger than the preceding, which covers it anteriorly, and 
arises from the upper two-thirds of the inner and posterior faces of the 
ulna, so as to envelop this bone almost entirely, and divides, but much 
deeper than the flexor sublimis, into four bellies, which become as many 
tendons. These tendons are retained together by numerous interme- 
diate filaments and by folds of the mucous sheaths, and pass under 
the palmar ligament of the carpus, with those of the preceding, and go 
to the same fingers. In this place we see a fissure along the upper 
and lower faces. They pass through the sheath of the flexor sublimis, 
afterwards become broader and thinner, and are attached to the base 
of the third phalanx. 

This muscle flexes the third phalanx of the fingers. 

§ 1156. Sometimes a muscle proceeds between the flexor sublimis 
and the flexor profundus, and extends from the inner condyle of the 
humerus to the latter ;(1) and again, a muscular fasciculus arises from 
the flexor pollicis longus as high as the wrist, which is attached by a 
tendinous expansion to that tendon of the flexor profundus which goes 
to the index finger.(2) 

VII. LIGAMENTS OF THE FLEXORS OF THE FINGERS. 

§ 1157. The tendons of the flexor profundus and sublimis are sur- 
rounded in two places by fibrous ligaments and mucous sheaths.' 

§ 1158. The upper fibrous ligaments are the common palmar liga- 
ment and proper palmar ligament of the carpus. 

Below them we find the upper mucous sheath, an elongated sac, 
which surrounds all the tendons of the two flexors, commences about 
an inch and a half above the radio-carpal articulation, and extends to 
the centre of the carpus. Its outer layer is attached to the palmar 
ligaments of the bones of the carpus, and to the interossei muscles. 
Numerous folds arise from all the internal face of this outer layer which 
go inward, surround the tendons of the two flexors, and unite them but 
very loosely. 

§ 1 159. The second place, where the common flexors are surrounded 
with similar ligaments, is that portion which corresponds to the lower 
face of the fingers. 

§ 1160. The lower fibrous ligaments are situated outwardly, and 
form for the mucous sheath an envelop, which is divided on account 
of the motion of the fingers. 

(1) Gantzcr, p. 13. 

(2) Gantzer, ibid. 



134 DEGCHIFTIVE AJfATOMY. 

The strongest portion is termed the ligamentous sheaths (Lig. vagi- 
nalia). These sheaths are formed almost entirely of transverse 
fibres ; in part, however, especially on the surface, of oblique fibres 
which cross the preceding. They are strongly extended, like a bridge, 
from the radial to the ulnar edge of the first and second phalanges. 
That of the indicator finger is much stronger than the others in every 

respect. 

The feeblest which stand more distinct, extend in the same manner 
over the metacarpo-phalangcean and the second phalangcean articula- 
tions. Their size diminishes much from the first to the third articula- 
tion. They are called the ligamentous rings of the articulations 
( annuli juncturarum ligamentosi). 

Analogous fasciculi are found between the preceding and the liga- 
mentous sheaths ; these are the oblique or crucial rings of the first and 
second phalanges (annuli obliqui, s. cruciati phalangis prima, et 
secundoz). 

§ 1161. The inner faces of these fibrous ligaments are covered with 
elongated mucous sheaths, which begin some lines behind the meta- 
carpo-phalangcean articulation, are attached in this place to the flexor 
sublimis and profundus of each finger, and extend to the centre of the 
terminating phalanx. Their upper part is inserted in the upper part of 
the palmar face of the phalanges. The tendons of the two flexors are 
mostly loose in these mucous sheaths, of which each finger possesses 
a separate one ; however, from the dorsal face of the sheaths, that which 
covers the palmar face of the fingers, arise several broader and narrower 
irregular folds, the largest of which contains more or less fat ; these 
proceed from before backward, are very thin from one side to the other, 
and are attached to the tendons of the flexor sublimis and profundus. 
The upper are usually very thin and rounded, and are attached to the 
radial slip of the flexor sublimis. They are generally deficient in one 
or several fingers. 

The succeeding which are larger are also more constant ; thej' 
arise near the second phalan^oean articulation, and are usually attached 
to the tendon of the flexor sublimis, where its two slips unite. Usually 
we find also within or on their sides other prolongations, which go to 
the tendons of the flexor profundus. 

A third prolongation generally arises from the base of the third pha- 
lanx which is attached directly to the two anterior slips of the flexor 
sublimis, unites them, goes from this point to the anterior extremity of 
the flexor profundus which covers the third articulation, and is there 
attached in all its extent. 

Other single or divided prolongations extend also in many parts 
between the tendons of the two flexors in their course along the 
fingers. 

These are the short and long accessory or vascular ligaments of the 
flexors (vincvla tendinum sublimis el profundi accessoria, s. vascvlosa 
brevia et longa). 



MYOLOGY. 135 



VIII. FLEXOH POLLICIS LONGUS. 



§ 1162. The flexor proprhis pollicis longus muscle, Radio-phalan- 
gettien du pouce, Ch., is much feebler and shorter than the preceding, 
with the second belly of which its central part usually adheres more 
or less intimately. It arises by a small distinct slip from the tubercle 
of the ulna, but in most of its length it arises by fleshy fibres from the 
lower two-thirds of the inner face, and the anterior edge of the radius. 
The strong tendon which terminates it passes under the palmar liga- 
ment with those of the two preceding muscles, and goes between 
the abductor and flexor pollicis brevis on the internal face of this finger, 
and is attached not far from its inferior edge to the second phalanx. 
This tendon is surrounded by a special mucous sheath from the lower 
extremity of the fore-arm to the centre of the first phalanx. 

It flexes the second phalanx of the thumb. 

We sometimes find a second head which comes from the inner 
condyle of the humerus, and which is only a greater development of its 
upper slip. 

IX. PEONATOK QUADBATUS. 

§ 1163. The pronator quadratus muscle, Cubito-radial, Ch. {M. pro- 
nator quadratus, s. inferior), is an almost equilateral quadrilateral mus- 
cle, being rather more long than broad, which occupies the lowest part of 
the inner face of the fore-arm, where it is covered by the tendons of all 
the long muscles. Its fibres are oblique and extend from the posterior 
edge and from the inner face of the ulna to the inner face and anterior 
edge of the radius. 

This muscle rotates the radius, and the hand with it, on its axis from 
behind forward and from without inward. 

§ 1164. It is sometimes deficient,(l) as in several mammalia- 

Again, it is sometimes divided into two bellies which are entirely 
separated, the fibres of which proceed in opposite directions and cross. (2) 



ARTICLE FIFTH. 

MUSCLES OF THE HAND. 

§ 1 165. The musclesof the hand(3)arisefrom the tendonsof the flexor 
profundus, from the carpus, and from the metacarpus, and are attached 
to the metacarpal bones and also to the phalanges. They are princi- 
pally designed to approximate and separate the fingers and serve less 

(1) We know of one instance. 

(2) We have once seen this. 

(3) Albinus, Iconcs musculorum Planus iv., ad calcem hist, viuscul., Leyden, 1734. 



136 DESCRIPTIVE ANATOMY 

to flex (hem. Hence they are divided into abductors, adductors, and 
flexors. The adductors and abductors which are attached to the two 
external fingers, the thumb, and the little finger, fulfill only the one or 
the other of these two functions, while those which move the other 
three fingers are both adductors and abductors ; because, in approxi- 
ting a finger toward that on one side, they necessarily separate it 
from that of the other side. 

The abductor and adductor muscles of the fingers, except the thumb, 
are] called the interossei muscles, from their situation ; the flexors of 
the second and third and also one of the little finger are called the lum- 
bricales, from their form. 

I. LUMBRICALES. 

§ 1166. The four lumbricales muscles, Palmi-phalangien, Ch, are 
long, rounded muscles, which arise fleshy from the lower face and the 
radial edge of the tendons of the flexor digitorum profundus toward 
the upper end of the metacarpus. They proceed at the side above and 
below these tendons and arrive at the fingers, where they become thin 
tendons, which are reflected on the radial face of the first phalanx, 
enlarge, and blend with the anterior edge of the tendon of the extensor 
muscle. 

They flex the first phalanx. 

§ 1167. We often find one or more of these muscles more or less 
completely double, and then the supernumerary head or the whole 
muscle is inserted in the ulnar side of the adjacent finger. 

II. INTEROSSKI. 

§ 1168. The interossei muscles, Mtlacarpo-phalangiens lateralis 
sus-palmaire and the metacarpophalangiens lateraux, Ch., are situated 
between the metacarpal bones. Their anterior tendons are attached 
partly to the lateral faces of the posterior heads of the first phalanges, 
partly also to the extensors of the fingers. They are divided into Two 
classes, the external (M. interossei externi, s. bicipites), and the internal 
(J\l. interossei intemi, s. simplices.) 

I. INTEROSSEI EXTERNI. 

§ 1169. The common characters of the external interossei mus- 
cles are . 1st. They appear on the dorsal and palmar faces of the hand. 
2d. They arise from the corresponding faces of two metacarpal 
bones by two heads, which is inserted in a common tendon 

We number four, which are attached to the index, middie, and little 
fingers. 

The first, which is the strongest, is situated between the thumb and 
the index finger It differs from the others, not only in volume but 
also m the complete separation of its two heads. 



MYOLOGY. 187 

The anterior and stronger head arisesfrom the upper larger partof the 
ulnar face of the metacarpal bone of the thumb. The posterior, which 
is smaller, arises from almost all the radial face of the second metacarpal 
bone. These two heads unite below in a common tendon, which is 
attached partly to the radial face of the base of the first phalanx 
of the index finger, and partly blends with the tendon sent by the 
common extensor of the same finger. 

The great distance between the two heads has led some anatomists 
to consider them as two distinct muscles : they have termed the ante- 
rior head the adductor indicis and the posterior the first internal inter- 
osseous muscle. 

It draws the second finger toward the thumb. 

The other external interosseous muscles are much smaller ; their 
heads unite much higher even in the centre of their course. 

The second arises by a smaller anterior and deeper head from the 
ulnar side of the second, and by a larger posterior looser head from the 
radial side of the third metacarpal bone. It is also attached to the radial 
side of the middle finger. 

This muscle brings the middle finger toward the index finger. 

The third, situated in the space between the third and fourth meta- 
carpal bones, is inserted in the ulnar side of the middle finger. 

It brings the middle finger toward the fourth. 

The fourth is placed between the fourth and fifth metacarpal bones, 
and is inserted in the ulnar side of the fourth finger. 

It brings the ring finger to the fifth. 

II. INTEBOSSEI INTEHNI. 

§ 1170. The interossei interni muscles are three in number, when 
we do not consider the posterior head of the first external interosseous 
muscle as the first internal interosseous muscle. They are attached to 
the second, fourth, and fifth fingers. They arise by a single head from 
the lateral face of the metacarpal bone of the finger to which they are 
attached, and are very distinct in the palm of the hand. 

The first arises from the ulnar face of the second metacarpal bone, 
is inserted in the ulnar side of the base of the first phalanx of the indi- 
cator finger, and blends in the same place with the tendon sent by the 
common extensor to this finger. It separates the index finger from the 
thumb and draws it toward the middle finger. 

The second comes from the radial side of the fourth metacarpal bone. 

The third arises from the radial side of the fifth metacarpal bone. 

The second is attached to the first phalanx of the fourth finger, and 
the third to the first phalanx of the fifth finger. 

Both draw the fingers to which they are attached from the side of 
the thumb or from the radial edge of the hand, and consequently in- 
ward. 

Vol. II. 18 



138 



DESCRIPTIVE ANATOMY. 



The index finger has then an external and an internal interosseous 
muscle ; the middle finger has two external interosseous muscles ; the 
fourth finger an external and an internal, and finally the fifth finger 
an internal interosseous muscle. 

§1171. The Interosseous muscles rarely present anomalies. We 
have however found the second external interosseous muscle attached 
to the ulnar side of the index finger, and the first internal interosseous 
muscle attached not to this finger but to the radial side of the third— a 
variety the more interesting in the history of the inversion of the organs 
because it presents an exact repetition of the normal formation of the 
foot, and because the hand in which we found it presented also an ad- 
ductor of the thumb, formed likewise in the same manner as that of the 
great toe. 

III. MUSCLES OF THE THUMB. 

§ 1172. The metacarpal bone of the thumb is surrounded by a con- 
siderable muscular mass, called the ball of the thumb (thenar), formed 
of four muscles, the abductor pollicis brevis, the opponens pollicis, the 
flexor pollicis brevis, and the adductor pollicis. 

I. ABDUCTOR POLLICIS BREVIS. 

§ 1173. The abductor pollicis brevis muscle, Carpo-sus-phalangicn 
dupouce, Ch., the most superficial of the four muscles, arises from the 
anterior part of the inner face of the ligament of the carpus and of the 
Os trapezium. It is generally blended by a short intermediate tendon 
with the tendon of the abductor longus (§1 139), and extending forward 
along the radial edge of the metacarpal bone of the thumb, it is at- 
tached by a short tendon to the outer face of the posterior head of its 
first phalanx. It also usually blends more anteriorly with the tendon 
of the flexor pollicis brevis muscle. 

It separates the thumb from the index finger and extends it a little. 

II. OPPONENS POLLICIS. 

§ 1174. The opponens pollicis muscle, Carpo-metacarpien dupouce, 
Ch., is smaller than the preceding, which it partly covers, and its form 
is rhomboidal. It arises below it by a broad edge and by very broad 
tendinous fibres from the anterior part of the inner face of the palmar 
ligament and from the os trapezium, then descends to the metacarpal 
bone of the thumb, and is attached by a short tendon to all the anterior 
part of its radial edge. 

It draws the thumb inward and turns it on its axis ; so that it op- 
poses its palmar face to that of the other fingers. 



MYOLOGY. 139 



III. PLEXOR POLLICIS BKEVIS. 



§ 1175. The flexor pollicisbrevis muscle, Carpo-'phalangien du pouce, 
Ch. (JVT. flexor pollicis brevis, s. mesothenar, s. antithenar), is stronger 
than the two preceding. Its upper extremity, which is very much 
divided, arises first below and inward from the palmar ligament and the 
os trapezium, on the other side from the palmar face of the os trape- 
zoides, from the os magnum, and the os pyramidale. It partly covers 
the preceding and is attached to the outer sesamoid bone of the thumb. 

It flexes the first phalanx of the thumb. 

§ 1176. The largest head, which comes from the palmar ligament, 
is sometimes entirely separated from the other, which is smaller and 
situated lower ; so that this muscle is in fact double. On the other 
hand, it often happens that the small head is entirely blended with the 
adductor pollicis muscle. 



IV. ADDUCTOB POLLICIS. 



§ 1177. The adductor pollicis muscle, Metacarpo-phalangien du 
pouce, Ch. (M. mesothenar, s. hypothenar), is the strongest and the 
deepest of the four muscles of this finger. Its form is triangular, the 
base looking toward the ulnar edge and the summit toward the radial 
edo-e. It arises by fleshy and tendinous fibres from the palmar face of 
the os magnum, and in a greater or less extent from the palmar edge 
of the third metacarpal bone, goes forward and outward, and is attached 
by a short tendon to the inner sesamoid bone. 

This muscle draws the thumb toward the index finger and slightly 
rotates it on its axis, so that it turns its palmar face toward that of the 
other fingers. 

§ 1178. Sometimes it divides into a posterior and an antenor belly, 
which are completely distinct, the posterior being the larger. In this 
case the first arises only from the os magnum or at the same time from 
this bone and a small upper portion of the third metacarpal bone : as 
to the second, it comes from the lower part of the anterior head of the 
third and fourth metacarpal bones ; sometimes also from the fifth as 
well as from the capsular ligament of the first phalangean articulation, 
and goes across or a little obliquely from before backward, to the first 
phalanx of the thumb, where it unites with the posterior head. 

This anomaly is worthy of remark, as it coincides perfectly with the 
normal arrangement of the adductor of the large toe. 



IV. MUSCLES OF THE LITTLE FINGER. 



& 1179. The little finger is moved by three muscles, an abductor, a 
flexor, and an adductor. 



140 DESCRIPTIVE ANATOMT. 



1. ADDUCTOIl MINIMI DICITI. 



§ 1180. The abductor minimi digiti muscle, Carpo-phalangicn du 
petit doigt, Ch., the shortest of these three muscles, extends along the 
ulnar edge of the metacarpus. It arises by short tendinous fibres from 
the pisiform bone, and near the first phalanx of the finger becomes a 
small flat tendon, which blends with the ulnar edge of the tendon of its 
extensor. 

It separates the little finger from the others. 



II. FLEXOR MINIMI DIGITI. 



§ 1181. The flexor minimi digiti muscle (JVf. flexor proprius digili 
quinti) is covered by the preceding. It arises below and before it from 
the pisiform bone and from the unciform process of the unciform bone : 
it forms a short tendon forward, which is attached to the radial side of 
the first phalanx of the little finger. 

It flexes the little finger and separates it from the others. 

It is often deficient and then the preceding is more developed. 

III. ADDUCTOR MINIMI DIGITI QUINTI. 

§ 1182. The adductor minimi digiti muscle, Carpo-metacarpien du 
petit doigt, Ch. (M. adductor digiti quinti), is thickest and shortest, and 
arises from the lower anterior edge and the outer face of the unciform 
process of the unciform bone, goes upward, and is attached to all the 
ulnar face of the metacarpal bone of the fifth finger. 

It carries the little finger forward and draws it toward the others, 
causing it to rotate around its axis on the metacarpal bone. When it 
acts in concert with the opponens pollicis muscle, which very much 
resembles it, the cavity of the palm of the hand enlarges. 

§ 1183. The proper muscles of the thumb and little finger are 
only the lumbricales or interossei muscles largely developed and 
divided into several fasciculi. We must consider the flexor pollicis 
brevis muscle as the first lumbricalis. The abductor pollicis brevis 
and the opponens polhcis correspond to an external ; the adductor repre- 
sents an internal interosseous muscle. 

The abductor and the flexor minimi digiti muscles form only one 
muscle, which represents the last external interosseous muscle. 

The adductor minimi digiti muscle is only an enlarged internal inter- 
osseous muscle. 



MYOLOGY. 141 

CHAPTER II. 

MUSCLES OF THE LOWER EXTREMITIES. 

§ 1184. The muscles which have with the upper section of the 
abdominal members relations similar to those which exist between the 
superficial muscles of the back and of the region of the shoulder, or the 
broad muscles of the abdomen, have already been examined. We may 
then pass immediately to those which go from the first section of the 
bones of the lower extremities to the femur ; but we must here also 
commence by describing the general aponeurotic envelop. 

ARTICLE FIRST. 

APONEUROTIC SHEATH OF THE LOWER EXTREMITIES. 

§ 1185. Most of the muscles of the lower extremities, especially 
those of the thigh, leg, and sole of the foot, are enveloped by an apo- 
neurotic expansion, which is not arranged every where in the same 
manner. 

This expansion is called on the thigh the fascia lata, on the leg the 
crural aponeurosis, in the sole of the foot the plantar aponeurosis. 

The first two form a whole more continuous with each other than 
with the plantar aponeurosis, and are also still more similar in their 
form, as they surround the thigh and the leg. 

The fascia lata commences behind on the gluteaeus maximus muscle, 
where it is very thin, and gradually loses itself at its upper portion. It 
arises forward from the iliac crest and from the Fallopian ligament. It 
extends as far as the knee. It adheres very intimately by the upper 
and external part of its anterior edge to the lower edge of the tendon of 
the obliquus externus abdominis muscle, to which it is much more 
loosely attached on its inner side. 

It is thickest at the outer part and thinnest at the inner part of the 
thigh. It is half a line thick in every part and above even a line in the 
first region, while it hardly equals the twelfth of a line in the second. 
In general it is evidently formed of two layers of fibres : the internal is 
stronger and its fibres are longitudinal ; the external is weaker and its 
fibres are oblique downward, inward, and backward, and are more insu- 
lated, and gradually approach each other from below upward. 

From the inner face of this aponeurosis arise septa which extend 
between most of the muscles of the thigh which they separate from 
each other ; we readily distinguish in most of these septa transverse 
and oblique fibres. 



142 DESCRIPTIVE ANATOMY. 

The fascia lata presents oblique fibres in every part, in ninny 
places, especially at the inner portion of its circumference, these I 
are extended over a layer which is not evidently fibrous, especially 
forward, but at the outer part this layer is manifestly formed of longi- 
tudinal fibres, and at the same time its inner face presents in diffi 
parts more insulated oblique fibres, so that here the aponeurosis evi- 
dently consists of three layers. 

The outer part of the crural aponeurosis is also much thicker, and 
formed in this part of two layers ; the fibres of the internal are longi- 
tudinal, those of the external, which is weaker, are oblique. 

At the upper part of the aponeurosis the direction of the oblique fibres 
is inversely that of the oblique fibres of the fascia lata, that is, they pro- 
ceed forward, downward, and inward. 

At the lower part of the crural aponeurosis they have an opposite 
direction, and at the same time other fibres are developed on the inner 
side of the aponeurosis, which are oblique from behind forward 
and from above downward. 

These outer and inner fibres cross on the anterior face of the articu- 
lation of the foot, and as they increase in strength in this part they 
there form the crucial ligament (Lig. cruciatum), composed of two 
fasciculi, which cross each other in the centre. One of these fasciculi 
descends from the outer malleolus, goes downward and inward, and is 
attached to the tibial side of the first metatarsal bone. The second 
arises from the internal malleolus, and goes to the tuberosity of the 
fifth metatarsal bone. 

Below, they are both continuous with the thin aponeurosis of the 
back of the foot, which covers the tendon of the extensor digitorum 
longus and the belly of the extensor communis digitorum pedis, and 
is lost near the anterior extremity of the metatarsus. 

This aponeurosis at the back of the foot is often much stronger 
toward the posterior end of the first metatarsal bone in this place, 
where it passes over the tendon of the extensor proprius pollicis pedis, 
than in the rest of its extent, and it is formed of very evident trans \ 
fibres which are attached internally to the inner side of the metatarsus, 
and outside to a special fasciculus of the extensor brevis digitorum 
pedis. In this case, this portion of the aponeurosis of the foot is pro- 
vided with a proper tensor muscle. 

II. TENSOR VAGIN.E FEMOKIS. 

§ 1186. The aponeurosis of the fascia lata, like most of the aponeu- 
rotic expansions which surround the muscles, has a proper muscle 
called the tensor vagina femoris muscle, llio-aponeurosi-femoral, Ch. 
(JVf. tensor fascia lata,). 

This muscle is situated at the anterior edge of the upper part of the 
lateral face of the thigh. It arises by a short but very strong tendon 
from the outer face of the anterior and superior spine of the ilium. 



MYOLOGY. 143 

Thence it goes downward and outward, gradually enlarges, and is 
continuous by very short tendinous fibres, towards the summit of the 
middle third of the thigh, with the fascia lata, which is united with its 
outer face more firmly than with any other muscle. 



ARTICLE SECOND. 

MUSCLES OF THE PELVIS. 

§ 1187. The muscles of the pelvis arise partly from its outer face, 
partly from its inner face, and partly from the lumbar portion of the 
vertebral column ; they are attached to the upper part of the femur 
which they extend, flex, and turn around its axis. 

I. EXTENSORS OF THE THIGH. 

§ 1188. The thigh is extended by three muscles called the glutwi, 
situated over each other ; and they cover the outer face of the iliac 
bones, and descend outward, downward, and forward toward the femur. 

I. GLUTEUS MAXIMUS. 

§ 1189. The glutaius maximus muscle, Sacro-femoral, Ch., is the 
largest of all the muscles of the body, and is nearly a regular rhomboid. 
It arises by its posterior and inner edge from the posterior part of the 
outer lip of the crest of the ilium, from the lower part of the posterior 
face of the sacrum, from the sacro-sciatic ligament, and from the sciatic 
tuberosity. It arises by these different points by short tendinous fibres, 
goes from within outward and from above downward, forming a very 
strong and thick muscle, composed of distinct and large fasciculi which 
are loosely connected with each other. It is attached by a broad and 
very strong tendon which is continuous below with the lateral part of 
the fascia lata to the lower part of the large trochanter, and to the linea 
aspera which descend from this tubercle. 

Several mucous bursae are found on the inner face of the lower tendon 
of this muscle. The largest and at the same time the uppermost is 
situated between it and the outer face of the large trochanter. Farther 
backward and downward we find another which is also large but a 
little smaller, between it the upper extremity of the vastus externus 
muscle and the lower end of the tensor vaginae femoris muscle. Fi- 
nally, between this muscle and the femur, farther backward and down- 
ward, are two which are smaller. 

The glutaeus maximus extends the thigh, brings it toward the ver- 
tebral column, rotates it a little outward, and approximates it to that of 
the side opposite. When it acts from below upward it draws the iliac 
bones downward, inward, and forward. 



144 DESCRIPTIVE ANATOMY. 



II. GLUTEUS MEDICG. 



§ 1190. The glutozus medius muscle, Grand ilio-trochanterien, Ch., 
is a large muscle, but smaller and closer than the preceding - , and haB 
a triangular form. It is covered at its posterior and lower part by the 
glutaeus maximus, and forward by the fascia lata only, with which it 
is intimately connected. It arises from the outer lip of the crest of the 
ilium, and from the upper and anterior part of the outer face of the 
iliac bones which is situated between the iliac crest and the curved 
line. Its posterior fibres are oblique from behind forward and from 
without inward ; the anterior go from above downward. It proceeds 
towards the large trochanter, and is attached to its outer face by a 
broad, short, and very strong tendon, which blends with that of the 
glutaeus maximus muscle. 

A small mucous bursa exists between the upper face of this muscle, 
the pyrifarmis, the gemellus superior, and the inner face of the large 
trochanter. 

The glutaeus medius muscle raises the femur, separates it from that 
of the opposite side, and inclines the pelvis as much as possible towards 
its side. 

Its posterior part turns the thigh outward, and its anterior turns it 
inward. 

III. GLUTJBUS MINIMUS. 

§ 1191. The glutaeus minimus muscle, Petit ilio-trochanterien, Ch., 
has the same form as the preceding, while it is much smaller and is 
entirely covered by it. It arises directly below it by its upper face and 
anterior edge from the curved line, and from the anterior and lower 
part of the outer face of the iliac bones. It is attached by a short and 
strong tendon to the upper edge of the upper part of the inner face of 
the large trochanter. 

A small synovial capsule exists forward between it and the large 
trochanter. 

Its action is the same as that of the preceding. 

II. MUSCLES WHICH ROTATE THE THIGH OUTWARDLY. 

§ 1192. The thigh is turned outward by six muscles, the pyriformis, 
the obturator internus, the obturator externus, the two gemelli, and 
the quadrat us femoris. 

I. PYRIFORMIS. 

§ 1193. The pyriformis muscle, Sacro-lrochanterien, Ch. (M. pyri- 
formis, pyrimidalis, iliacus externus), is a small muscle of an oblong 



MYOLOGY. 145 

triangular form coming from the cavity of the abdomen, where it arises 
by three or four digitations from the sacrum. It arises from the anterior 
face of this bone, between the third and fourth, the second and third, 
and the first and second pairs of the anterior foramina of the sacrum, 
and from the inner face of the posterior and lower spine of the ilium, 
and from the upper part of the posterior edge of the iliac fossa. It 
descends through this last behind the upper part of the descending 
branch of the ischium, goes outward and forward, and is attached by 
a rounded, strong, and proportionally broad tendon to the summit and 
upper part of the inner face of the large trochanter. 

There is a small mucous bursa between its tendon and the gemellus 
superior muscle. 

It rotates the thigh outward, separates it from that of the side opposite, 
and raises it a little. 

§ 1194. It sometimes divides into an upper and a lower portion, 
between which the glutaeal nerve passes. (1) 

II. OBTURATOR INTERNUS. 

§ 1195. The obturator interims muscle, Sous-pubio-trochanterien 
interne, Ch. (JVT. obturator internus, s. marsupialis, marsupialis inter- 

nus), arises from the inner face of the obturator foramen by radiating 
fibres, which suddenly change their direction on leaving the pelvis and 
turn at a right angle on the posterior face of the descending branch of 
the ischium, covered before by this part of the bone, and behind by the 
sacro-sciatic ligament. It then proceeds outward and forward; and is 
attached by a strong tendon to the central part of the inner face of the 
great trochanter, far below the tendon of the pyriformis muscle. 

The arrangement of this tendon is then very peculiar. It begins 
within the pelvis, a short distance from the descending branch of the 
ischium, but extends to about the centre of the space between the 
ischium and the trochanter. It does not appear except on the anterior 
and inner face of the muscle, where it consists of five very regular and 
very distinct fasciculi, two of which form the upper and lower edge of 
the muscle. The outer extremity of the middle belly extends between 
them by four triangular fasciculi, and then immediately unite in a 
strong tendon near the centre of the space between the ischium and 
the great trochanter. 

We find an oblong synovial capsule backward and outward between 
the tendon of this muscle, the gemelli, and the great trochanter. A 
second, external and rounded, situated between the ischiatic spine and 
the great trochanter, surrounds the inner part of the tendon. 
. The obturator internus muscle turns the thigh directly outward and 
draws it from that of the opposite side. 

(1) Winslow, Expos, anat., vol. ii. p. 125. 
Vol. II. 19 



146 DESCRIPTIVE ANATOMY. 



III. GEMELLI. 



§ 1196. The gemelli muscles, Ischio-trochanterien, Ch. (JIT. gemini 
femoris, marsiqnales externi, marsvpium), are two small oblong mus- 
cles, which are very similar and placed one over the other: they are 
separated backward and outward by the tendon of the obturator inter- 
ims muscle, also by that portion of this muscle which is situated out 
of the pelvis. Their thin edges touch forward. 

The upper arises by a pointed extremity from the lower part of the 
posterior face of the ischiatic spine. 

The loiver arises by a broad and semilunar edge from the upper faro 
of the sciatic tuberosity and from the outer face of the desce 
branch of the ischium. It gradually becomes thicker from within out- 
ward. 

These two muscles are intimately connected with the obturator 
interims, especially in their outer portions, entirely cover it, and are 
attached with it to the inner face of the great trochanter. 

They act in the same manner as the preceding. 

§ 1197. The upper gemellus is frequently deficient(l) — a remarka- 
ble analogy with what is seen in the ape. (2) 

We know of one case where both these muscles were deficient, as 
in bats. 

IV. QUADRATUS FEMORIS. 

§ 1198. The quadratics femoris muscle, Ischio-soustrochanterien^Ch.^ 
is oblong and composed of transverse fibres. It is broader from with- 
out inward than in any other direction, and its height much exceeds 
its thickness. It arises from the anterior edge of the sciatic tuberosity 
and from a small part of the ascending branch of the ischium, passes 
directly below the gemellus inferior to the posterior face of the lemur, 
where it is attached to a* square impression situated between the roots 
of the large and small trochanters above the posterior intertrochanterian 
line. 

We find a synovial capsule between it and the small trochanter. 

It acts like the preceding. 

§ 1199. Sometimes it does not exist. (3) More rarely it is divided 
into several fasciculi, three of which have been known to exist. (4) 

V. OBTURATOR EXTERNUS. 

§ 1200. The obturator externus muscle, Sous-pubio-trochanlerien 
externe, Ch., is a rounded and triangular muscle, at first thin, but after- 

(1) Gantzer, p. 4. 

(2) Vicq. d' Azyr, Enc. moth, syst. anat. des quadrvp., p. 29. 

(3) Albums, loc. cit., p. 530. — We know of one case where the gemelli were very 
largre. 

(4) Jancke, Dc caps. tend, articul., Leipsic, 1753. 



MYOLOGY. 



147 



wards it becomes thicker and again grows thinner. It arises by a 
rounded edge from the outer face of the ascending branch of the ischium 
and by short tendinous fibres from the two branches of the pubis and 
from the anterior face of the obturator membrane, 

After contracting considerably in its outer portion and being covered 
by a broad tendon on its anterior and posterior faces, it is reflected from 
the anterior to the posterior face of the body, goes obliquely upward 
and outward directly behind the neck of the femur, and is attached by 
a short but very strong tendon to the fossa and to the inner face of the 
great trochanter, a little distance below the tendons of the obturator 
internus and the gemelli muscles. 

It turns the thigh outward, draws it backward toward that of 
the opposite side, and brings the anterior face of the pelvis to its 
side. 

III. FLEXORS OP THE THIGH. 

§ 1201. There are two flexors of the thigh, the psoas magnus and 
the iliacus internus muscles : to these a third is usually attached, the 
psoas parvus muscle ; but this does not always descend to the thigh. 

I. PSOAS MAGNUS. 

§ 1202. The psoas magnus muscle, Prelombo-trochanterien, Ch. (JVT. 
psoas magnus, s. lumbaris, s. lumbaris internus), is a considerable elon- 
gated and rounded muscle, occupying the inner and anterior part of 
the lumbar region directly on the side of the bodies of the lumbar ver- 
tebra. It extends from the upper extremity of this region downward 
and outward to the inner face of the femur. 

It arises by an external and posterior and an internal and anterior 
range of short, flat, and triangular slips from the five lumbar vertebra? 
and the last dorsal. 

The anterior slips come from the lateral faces of the short ligaments 
and the intervertebral ligaments ; the posterior arise from the lower and 
anterior parts of the transverse processes of the lumbar vertebrae. 

The belly of this muscle descends outward, covers the inner part of 
the iliacus internus, becomes rounded as it descends, and forms before 
the sacro-iliac articulation, rather outward than inward, a strong tendon 
which emerges from the abdomen below the crural arch behind the 
femoral vessels, and is attached to the anterior face of the small tro- 
chanter. 

The psoas magnus muscle bends the thigh and turns it a little 
inward, bends the trunk and turns it a little toward its side. 

§ 1203. Between this muscle and the iliacus internus we sometimes 
find another smaller, which arises from one or more transverse pro- 
cesses of the upper lumbar vertebrae, proceeds on the outside of the 
psoas magnus muscle, and is attached to the small trochanter and 



148 DESCRIPTIVE ANATOMT. 

sometimes to the tendon of the last. Tho crural nerve usually passes 
between it and the psoas magnus muscle.(l) This anomaly reminds 
us of the multiplication of the psoas magnus muscle in several apes.(2) 
This and not the next muscle, as some anatomists assert, is the 
muscle which sometimes exists abnormally.(3) 

II. PSOAS PARVUS. 

§ 1204. The psoas parvus muscle, Prelombo-pubien, Ch., has an 
oblong square form, and arises from the lateral face of the first lumbar 
vertebra, and from the intervertebral ligament between it and the last 
dorsal vertebra, and sometimes from the twelfth dorsal vertebra. It 
arises generally by one but sometimes by two slips, which come either 
from the two vertebra? or only from the first lumbar. 

Jt soon after becomes a flat and very long tendon, situated on the 
outside of the psoas magnus muscle, crosses it to go inward, and is 
attached in that part where the body of the pubis and ilium unite. 

Below, the tendon becomes an aponeurosis, which covers the lower 
part of the psoas magnus and of the iliacus, is attached to the crural 
arch, and blends with the fascia lata. 

This muscle bends the vertebral column forward and increases the 
force of the two muscles situated above it, furnishing them with a point 
of support. 

§ 1205. It is sometimes deficient, but this is rare. 

III. ILIACDS INTERNUS. 

§ 1206. The iliacus internus muscle, Hiaco-trochanferien, Ch. (M. 
iliacus, s. iliacus internus), is a broad and considerable muscle, which 
fills all the upper part of the inner face of the iliac bones, whence it 
descends to the inner part of the thigh. It arises by a semicircular and 
convex edge and by short tendinous fibres from the inner lip of the iliac 
bone, and also by fleshy fibres from the inner face of this bone to near 
the anterior and inferior iliac spine, goes inward and forward, becomes 
in its course considerably narrower and thicker, and is attached a little 
above the crural arch to the outside of the tendon of the psoas magnus 
muscle, by which it is fixed to the anterior face of the small trochanter. 

We find a considerable mucous bursa between the common tendon 
of the psoas magnus and the iliacus internus muscle and the capsular 
ligament of the coxo-femoral articulation. There is another, which is 
smaller, between it and the small trochanter. 

This muscle bends the thigh and carries it inward. It draws the 
pelvis and with it the trunk downward and forward. 

(1) We have seen it several times. — Albinus, p. 315. 

(2) Valentine, Amph. zoot., p. 151. 

(3) Kelch, Bcytrage zurpath. anat., p. 22. 



MYOLOGY. 149 



ARTICLE THIRD. 

MUSCLES OF THE THIGH. 

§ 1207. Among the muscles which form the mass of the thigh some 
serve to move it and others act on the leg. Not only the first but also 
some of the second arise from the bones of the pelvis. 

The muscles of the first class are the adductors of the thigh; those 
of the second are the adductors, the flexors, and the extensors of the leg. 

I. ADDUCTORS OP THE THIGH. 

§ 1208. The two lower limbs are drawn toward each other by the 
adductors (adductores), which form almost all the internal and posterior 
part of the muscular mass of the thigh. Three of these muscles in 
particular have been termed the adductors. They have been considered 
as forming only a single muscle, called the triceps muscle (JYI. femoris 
triceps), but wrongly, as they are not united by a common tendon. 
The fourth has been desciibed as a separate muscle, called the pecti- 
nozus, although it might be considered as a fourth head of the common 
adductor, as well as the other three. 

I. PECTIN.EUS. 

§ 1209. The pectinozus muscle, Sous-pubio-femoral, Ch. (M.pecti- 
nceus, s.pectiualis), a flat, long, quadrangular muscle, arises by its upper 
thin and horizontal edge from the crest of the horizontal branch of the 
pubis, on which its upper and anterior face passes. It goes from above 
downward, from within outward, and is attached by a perpendicular 
edge to the upper end of the inner lip of the rough line of the femur. 

We find a small synovial capsule below the small trochanter, between 
this muscle and the femur. 

It draws the thigh toward that of the opposite side, raises it and car- 
ries it forward, turns it a little inward, and slightly inclines the pelvis 
outward and downward. 

§ 1210. We sometimes find a second pectinaeus, which is smaller, 
which blends below with the tendon of the other, and is attached above 
to the inner part of the upper edge of the obturator foramen.(l) 

§ 1211. The three adductors, properly so called, are distinguished 
into the long, the short, and the great adductor. 

II. ADDUCTOR LONGUS. 

§ 1212. The adductor longus muscle, Pubio-femoral, Ch. (M. ad- 
ductor femoris longus, caput primum tricipitis), has the form of an ob- 

(1) Winalow, Expos, anat., vol. i. p. 117. 



150 DESCRIPTIVE ANATOMY. 

long triangle. It is the second of the three adductors in size and the 
longest of all. It arises by a short, narrow, but very strong tendon 
from the inner part of the anterior face of the horizontal branch of the 
pubis, from the spine of the pubis, and from the anterior part of the 
symphysis pubis. Thence it goes outward and downward, in a direc- 
tion more oblique than the preceding, becomes broader and at the same 
time thinner, and is attached by a tendinous and interrupted edge to 
the third quarter of the posterior lip of the rough line of the femur. Its 
lower end usually unites to the vastus internus muscle. 

Its action is nearly the same as that of the pectinaeus. 

§ 1213. It is sometimes divided into two. And again, it descends 
much lower, by a thin tendon united to that of the adductor magnus : 
so too in some mammalia and in birds the pectinaeus or the other por- 
tions of the adductor muscle descend very low. 

III. ADDUCTOB BHEVI9. 

§ 1214. The adductor brevis muscle, Sous-pubio-femoral, Ch., (M. 
adductor femoris brevis, s. adductor secundus, s. caput alteram tricipitis). 

is rather a broad triangular muscle. It arises at the side of the tendon 
of the gracilis muscle, but much higher and more externally than it, 
and is closely united with its upper extremity. Its upper end, situated 
directly below the adductor longus and formed of very short tendinous 
fibres, arises from the inner part of the outer face of the horizontal branch 
of the pubis. It is much broader and much shorter than the preceding, 
goes less obliquely outward than it, and is attached to the posterior 
face of the small trochanter and also to the upper third of the inner lip 
of the rough line of the femur, by several strong tendinous slips, which 
succeed each other from above downward. 

At its lower extremity it is connected more or less intimately with 
the pectinaeus and the adductor magnus muscles. 

It acts like the preceding. 

§ 1215. It is often partially or wholly divided into two slips, which 
forms a remarkable analogy between man and the ape. 

IV. ADDUCTOR MAGNUS. 

§ 1216. The adductor magnus muscle, Ischiofemoral, Ch. (M. 
adductor femoris magnus, s. caput tricipitis tertium), is the largest of 
the three proper adductor muscles ; it also has a triangular foim, the 
base of which rests in the thigh, and the apex looks toward the pelvis. 
It arises from the anterior face of the descending branch of the pubis, 
and is intimately connected in this part with the outer face of the lower 
part of the tendon of the gracilis muscle. It arises also from the 
ascending branch of the ischium and from the lower edge of the sciatic 
tuberosity. 

Its upper and anterior fasciculi go directly ^downward and outward. 
The posterior and inferior on the contrary, which are attached to the 



MYOLOGY. 151 

sciatic tuberosity, go from below upward, around and behind the latter, 
so that the muscle seems at its upper part to have been twisted on 
itself, and is much thicker there than in the rest of its course. 

Before the extremity of the portion inserted in the sciatic tuberosity, 
the upper edge, which is loose and fissured in a semilunar form, goes 
toward the femur, where it is attached to the posterior lip of the linea 
aspera, behind the pectina^us and the other two adductors, alwaj^s 
descending deeper than they. The lower tendon is very strong, parti- 
cularly at its lower part, and extends to the posterior face of the inner 
condyle of the femur. 

About the latter fourth of the thigh this tendon is perforated by the 
superficial vessels of the leg, which pass from its anterior to its posterior 
face. It unites below to the vastus interims muscle. 

This muscle draws the thigh inward, carries it forward, turns its 
anterior face a little outward, flexes the pelvis forward, and directs its 
anterior face to the side. 

§ 1217. We sometimes find it divided into two portions, as in apes. 

II. MUSCLES OF THE THIGH WHICH MOVE THE LEG. 

§ 1218. The muscles situated on the thigh forming its mass, and 
which move the leg, are distinguished into adductors, extensors, and 
flexors. 

I. ADDUCTORS OF THE LEG. 

§ 1219. Those nearest the surface are the adductors, of these there 
are two, the sartorius and the gracilis. 

A. 6AHT0BIUS. 

§ 1220. The sartorius muscle, Mo-pretibial, Ch., the longest of all 
the muscles of the body, is very thin, and has an elongated square 
form. The short tendon by which it arises descends lower on its ex- 
ternal than on its internal edge. It is inserted directly at the side of 
the tensor vaginae femoris muscle, more inward and forward, on the 
anterior and upper spine of the iliac bone. Thence it passes onward 
and inward, above the lower part of the adductor longus and adductor 
magnus muscles. In this manner it attains the anterior face of the 
thigh, where its lower portion goes to the inner face of the same part. 
Thence it proceeds directly forward and at the side of the gracilis, and 
soon becomes rounder and narrower, and forms a short rounded 
tendon which, passing behind and below the inner condyle of the 
femur, comes to the inner face of the leg. In this place it rests directly 
on the upper part of the inner face of the tibia, it becomes broader, and 
is attached by its anterior edge to the inner face of this bone, near its 
spine, and is contiguous below with the aponeurotic expansion of the 
leer. 



152 DESCRIPTIVE ANATOMY. 

This muscle flexes the knee, and when this articulation is bent it 
turns the tibia inward, so that the end of the foot approaches the oilier. 
When it acts in an opposite direction it draws the haunch a little for- 
ward and turns it inward. 

6 1221. We have met with one subject in which the sartorius 
muscle did not exist. 

Sometimes, on the contrary, there are two which may happen in 
several different ways.(l) The normal muscle usually appears 
curved inward, and the additional muscle terminates sooner below, 
where it is attached either to the tendon of the first or to the femur. 

Sometimes the fibres of the sartorius muscle are interrupted by a 
considerable intermediate tendon which is firmly united to the fascia 
lata.(2) 

B. GRACILIS. 

§ 1222. The gracilis muscle, Sous-pubio-pretibial, Ch. (M. gracilis, 
s. rectus interims), is a thin muscle of an oblong triangular form which 
arises by a broad base which forms its upper edge, from the anterior face 
of the lower portion of the descending branch of the pubis, and from 
the upper part of the ascending branch of the ischium. Thence one 
of its edges turns forward and the other backward, one of its faces out- 
ward and the other inward ; it goes to the inside of the thigh, and 
above its latter sixth, becomes a thin and rounded tendon, which pro- 
ceeds directly behind the lower part and the tendon of the sartorius, 
and turns with it on the inner condyle of the femur. It is at first 
covered by it, and is then situated below it, and blended with it in its 
anterior and inferior part, and is finally inserted a little lower clown, in 
the upper part of the inner face of the tibia. 

It bends the knee, turns the leg inward, and draws the anterior face 
of the iliac bones from the side to which it is attached. 

II. EXTENSORS OF THE LEO. 

§ 1223. The leg has four extensors which may very properly be 
considered as one muscle with four heads, since they are attached to 
a common tendon. They are situated directly below the fascia lata 
aponeurosis on the anterior face, and on the sides of the thigh, and 
form most of its muscular mass. A considerable mucous bursa exists 
between them and the aponeurosis of the thigh. They are termed 
the rectus femoris, the vastus internus, the vastus cxternus, and the 
cruraeus muscles. 

A. RECTUS FEMORIS. 

§ 1224. The rectus femoris muscle, llio-rolulien, Ch. (M. rectus 
femoris, s. extensor cruris medius superficialis), is a strong elongated 



1) Huber, Act. n. c, vol. x. p. 114.— Rosenmuller, loc. cit., p. 7.— Gantzer, p. 14. 
1) Kelch, loc. cit., p. 42, p. xxxv. 



MYOLOGY. 153 

pointed muscle situated on the anterior face of the thigh, directly under 
the fascia lata aponeurosis in most of its length, except its upper part, 
where it is covered by the sartorius muscle. 

It arises by two points from the iliac bone by a very strong bat short 
tendon. In fact, this tendon is divided above into two heads, an upper 
and a lower or external tendon. 

The upper head, which goes directly downward, comes from the 
anterior and inferior spine of the ilium. The lower, which is curved in 
a semicircle, arises from the upper part of the edge of the cotyloid 
cavity. These two heads soon unite to give rise to the ripper common 
tendon. This tendon soon disappears on the posterior part of the 
muscle, but becomes much broader on the anterior, and descends to its 
centre, gradually becoming thinner. 

The central fleshy portion is composed of an outer and an inner 
layer of fibres, which unite at an acute angle on the median line, so 
that the arrangement of these fleshy fasciculi resembles in some mea- 
sure a roof. 

The fibres are much longer, and ascend much straighter the nearer 
they are to its lower extremity. They are attached on both sides to 
a prolongation of the upper tendon, the direction of which is from 
before backward, which descends into the substance of the muscle from 
its anterior face, and gradually diminishes from above downward. It 
however continues perceptible to near the lower end of the fleshy 
belly, that is, much lower than the broad and anterior part of the upper 
tendon descends on its outer face. It is nowhere connected with the 
posterior and inferior tendon. 

The lower tendon is much longer but is weaker than the upper. It 
ascends on the posterior face of the muscle, much higher than the upper, 
descends on the anterior, so that the fleshy belly is situated for several 
inches before and behind between two tendinous expansions. It 
begins to be visible forward only towards the lower third of the thigh, 
and is seen first on the two sides of the fleshy behy, which gradually 
contracts. It is entirely loose after quitting the last fifth of the thigh. 
When approaching the patella below, it becomes broader, and is 
attached to the upper edge of this bone, and is intimately united with 
the tendons of the other extensors. 

This muscle extends the leg when the thigh is fixed, and the thigh 
when the leg is fixed ; in the latter case it also bends thc"pelvis a little 
and turns its anterior face obliquely to the opposite side. 

U. VASTUS EXTEUNUS. 

§ 1225. The vastus extemus muscle, (.1/ extensoi cruris vash 
extemua),(l) the largest of nil the extensors of ihc leg, although much 
shorter than the preceding, forms almost solely the muscular mass on 
the outside of the thigh ; at the same time it extends very much 

(1) This and the next two muscles are termed the Trifcmoro-rotulicn by Chauseier. 
Vol. II. 20 



154 DESCRIPTIVE ANATOMT. 

backward and forward. It is considerably thick, but it is broader from 
before backward than from within outward. 

It arises by a slightly concave edge which inclines from before back- 
ward, from within outward, and from above downward, from the lower 
part of the anterior and outer face of the great trochanter. The 
upper half of its posterior edge, situated along the rough line of I he 
the femur, comes from the inner face of the outer wall of the fascia lata 
aponeurosis. From all these points it gradually descends forward, 
becomes narrower, and is finally attached, by an inferior tendon, to the 
upper and outer edge of the patella. The inner part of this tendon is 
covered some distance above its insertion by the tendon of the rectus 
femoris muscle, to which it is even slightly united, although it is easily 
separated from it as far as where it is inserted in the patella. 

The muscular fasciculi go directly downward. The upper tendon 
extends below the centre of the muscle on its outer face, and the low i j 
only to the centre of its inner face. 

The vastus extcrnus muscle extends the knee, and most generally 
raises the leg at the same time, and turns it a little outward. 

C. VASTUS JNTERNUS. 

§ 1226. The vastus interims muscle (JVT. extensor cruris, s. vastus 
interims) is a little shorter and much weaker than the preceding, with 
which it is blended outwardly in a small portion of its upper extremity. 
It arises by its upper edge, which descends obliquely inward, from the 
anterior intertrochanterian line ; by a small part of its lower edge, from 
a part of the anterior face of the femur situated below this line; and 
by the upper part of its posterior edge, from the upper part of the ante- 
rior lip of the linea aspera. Its lower tendon is attached to the inner 
part of the upper edge, and to the inner edge of the patella. The inner 
part of this tendon is covered below by that of the vastus cxternus 
which passes obliquely over it, and is attached to the patella before 
it ; it adheres to this tendon, but is easily separated from it. 

The upper tendon of this muscle descends over almost the whole of 
the inner and loose face on the posterior half of the muscle, while the 
lower disappears already below the centre of its outer face, principally 
at its upper part. 

This muscle extends the leg and turns it a little inward. 

D. CRURiEUS. 

§ 1227. The crurceus muscle, (JVT. cruralis, s. crurcatis, s. few or mis) 
the shortest of the four extensors of the leg, is also nearly as strong as 
the preceding. It arises by its posterior and inner face, directly below 
this last, from the larger part of the anterior and the outer face of the 
femur, excepting a small portion above, and from its lower third. The 
posterior edge comes from the outer lip of the linea aspera. This 



MYOLOGY. 155 

muscle covers also most of the anterior and outer faces of the femur. 
It is attached by its lower tendon behind the vastus interims and the 
vastus externus to the upper edge of the patella, and usually also at 
its lower and outer part, by short fibres, to the synovial capsule, and 
to the outer edge of the patella. 

This lower and outer part is generally separated from the others, 
particularly from their tendon. 

The upper edge of this muscle is attached to the bones without any 
appearance of a tendon. The lower tendon, the loose portion of which 
is longer than that of the two preceding, begins on the contrary from 
the middle of the anterior and loose face. 

The crurauis muscle is mostly covered above by the vastus externus 
and the vastus internus ; it is entirely covered below by the rectus 
muscle, excepting however its outer and lower lateral face, where it is 
concealed by the vastus internus muscle. Its lower part also is inti- 
mately connected with the two vasti, especially the externus. 

A capsular ligament exists between its tendon, that of the vastus 
externus, the capsular ligament and the patella ; this frequently opens 
into the femoro-tibial articulation. 

It extends the knee. 

§ 1228. The common tendon of these four muscles, after envelop- 
ing the patella, goes to attach itself to the tuberosities of the tibia, 
where we find a considerable synovial capsule between it and the bone. 

E. SUBCEUEAHS. 

§ 1229. The subcruralis muscle is a small triangular muscle, which 
always exists and is entirely covered by the lower part of the preced- 
ing. It arises from the lower fourth of the anterior face of the femur, 
and is attached to the upper part of the anterior wall of the synovial 
capsule of the knee. It draws this capsule in the motion of extending 
the leg, and also prevents it from being injured. 

III. FLEXORS OF THE LEG. 

§ 1230. The flexors of the leg are situated on the posterior face of 
the thigh. We number three, two internal and an external ; but the 
latter arises by two heads. All arise at the side of each other from 
the sciatic tuberosity, and are attached posteriorly to the bones of the 
leg. They consequently bend the knee or draw the posterior faces of 
the thigh and of the leg towards each other. They also extend the 
coxo-femoral articulation when the leg is extended. 

I. INTERNAL FLEXORS. 

§ 1231. The two inner or tibial flexors arise from the sciatic tube- 
rosity and are inserted in the upper end of the tibia. They are called 
the semimembranosus and the semitendinosus. 



156 DESCRIPTIVE ANATOMY. 



i >-ENDlN03US. 



§ 1232. The semitendinosus muscle, lachio-pretibial, Ch. (M 
tendinosus, s. sminervosus), is an elongated muscle broader and thicker 

above than below, partially covering the following, because it is ex- 
tended move below it and nearer the surface. It arises from the inner 
part of the posterior face of the sciatic tuberosity by a tendon which is 
very distinct outwardly, while its summit adheres very intimately to 
the inner edge of that of the long head of the biceps femoris muscle. 
This muscle is the most internal of the three flexors, and goes directly 
downward. Its lower tendon commences on its inner edge, a little be- 
low the centre of the fleshy belly ; from about the last fourth of the 
thigh it forms a very strong rounded cord, which passes behind the 
inner condyle of the femur to arrive at the tibia, and is attached, after 
enlarging and becoming thinner, to the inner face, directly below the 
gracilis muscle. It blends with the lower edge of the tendon of this 
latter muscle, and generally divides below into an upper and a lower 
slip. 

We find a mucous bursa directly near its insertion, between its upper 
tendon and that of the semimembranosus and the long head of 
the biceps. There is also another, and sometimes two or three, even 
between its lower tendon ; that of the sartorius, that of the gracilis, and 
the internal lateral ligament of the knee. 

This muscle bends the leg and turns it a little inward ; when it acts 
in an opposite direction it draws the pelvis and the trunk backward, 
and bends them with the thigh in the same direction. 



B. SEMIMEMBRANOSUS. 



§ 1233. The semimembranosus muscle, Ischio-popliti-tibial, Ch. (M. 
semimembranosus), follows a direction to a certain exent directly oppo- 
site to that of the preceding. Of the three flexors this arises farther 
forward, upward, and outward from the outer part of the sciatic tubero- 
sity by a very long, strong, broad, and perfectly distinct tendon, which 
gradually enlarges and becomes thinner as it descends to the centre of 
the thigh and to the end of the fleshy belly, to which it is united by an 
edge oblique from within outward. This belly is elongated, rounded, 
thicket, but shorter than that of the semitendinosus, and is formed of an 
internal and an external layer of fibres which are turned upward 
towards each other, and are attached by radiations to the upper tendon. 
This latter exists only on the outer face of the upper part of the muscle ; 
but from its centre to its lower end, where it appears externally as a 
narrow band, it penetrates deeply inward to the centre of its substance. 
The lower tendon, which proceeds nearly to the centre of the muscle 
on its anterior face and on its inner edge, passes on the outer face of 
the inner condyle of the femur, between it and the semitendinosus 



MYOLOGY. 157 

muscle, and is inserted to the inner part of the inner condyle of the 
tibia, after passing freely a short distance. 

A mucous bursa exists between the upper tendon and the quadratus 
femoris or the adductor magnus. Sometimes there are two. Another 
is found between the lower tendon, the upper internal head of the gas- 
trocnemius and the capsular ligament of the knee. This bursa often 
encloses another which is smaller, and adheres very intimately to the 
tendon of the semimembranosus muscle. 

The action of this muscle is the same as that of the preceding. 

II. BICEPS FEMOEIS. 

§ 1234. The biceps femoris muscle, Ischio-femoro-peronier, Ch. (JW. 
flexor cruris externus, s. fibularis, s. biceps ftmoris), arises above by 
two separate heads, which are attached below by a common tendon. 

The long head arises from the posterior face of the sciatic tuberosity 
by a short but firm tendon, which is inserted between the two preceding 
muscles. A short distance from its upper extremity this tendon begins 
to receive the fasciculi of the fleshy belly, and descends along its inner 
edge. The belly descends at first in a straight line, behind and at the 
side of the upper part of the semimembranosus muscle ; but it then 
goes outward, passes over the adductor magnus, and thus arrives at 
the outside of the thigh. 

The short head is much smaller, and its form is an oblong square. 
It arises by very short tendinous fibres from the central two fourths 
of the outer lip of the linea aspera, directly at the side of the adductor 
magnus, goes obliquely downward, and is attached to a the inner face of 
the lower tendon of the long head, from the lower fourth of the thigh 
to near its lower end. 

The common inferior tendon, which goes nearly to the centre of the 
large belly, on its posterior face, descends on the outer face of the outer 
condyle of the femur, and is inserted at the top of the head of the 
fibula, where there is a mucous bursa between it and the external 
lateral ligament of the knee. 

The biceps femoris muscle bends the knee, turns the leg a little out- 
ward, extends the pelvis, and inclines it slightly downward and back- 
ward. 

§ 1235. Sometimes the short head does not exist, a remarkable ana- 
logy with animals, in most of which it is deficient. But in other sub- 
jects we find a third, which is thinner, and comes sometimes from the 
sciatic tuberosity, and is attached below the common tendon of the 
muscle,(l) and sometimes arises from the upper part of the long head, 
descends on the calf of the leg, and is joined by the lower end to the 
tendo Achillis;(2) this deserves to be remarked because the biceps 
femoris muscle descends very low in the mammalia. 

(1) Gantzer, loc. cit., p. 15.— Soemmering, Muskelehre, p. 276. 

(2) Kelch, loc. cit., p. 42, no. xxxvi. 



158 DESCRIPTIVE ANATOMY. 

When this anomaly exists the biceps femoris resembles the normal 
structure of the biceps flexor cubiti, even as the latter, when it presents 
a third supernumerary head, represents the anomaly, of which the 
other sometimes irives an instance. 



ARTICLE FOURTH. 

MUSCLES OP THE LEG. 

§ 1.236. The muscles of the leg occupy its posterior, external, and 
anterior faces ; but they leave the internal loose, so that on this side 
the tibia is covered only by the skin. Most of them are attached, 1 » v' 
their upper extremities, to the bones of the leg, and by their lower,to those 
of the feet as far as the toes. Some, however, come from the lower 
part of the thigh, their lower extremities arc inserted in the bones of 
the leg. 

I. POSTERIOR MUSCLES. 

§ 1237. The posterior muscles of the leg form two layers, a super- 
ficial and a deep layer. 

I. SUPERFICIAL LAYER. 

§ 1238. The superficial layer of the posterior muscles of the leg is 
composed of two muscles, the triceps suraj and the plantaris. 

A. TttlCEPS SUB*. 

§ 1239. The triceps surce muscle (J\l. triceps surce, s. gemelli cum 
soleo) is extremely strong, and forms most of the muscular mass of (he 
leg ; it deserves to be considered as a separate muscle with thj 
since these heads, although entirely separated above, are all attached 
below to a common tendon. 

Two of these heads are in pairs and the third is single. The first 
two called for this reason the gastrocnemii muscles, Bi-femoro-calca- 
niens, Ch. (j\I. gemelli sura), are situated at the side of each other. 
They arise by a short, broad, but thin tendon, which terminates above 
by a semicircular convex edge from the femur, above the upper edge 
of the posterior face of its inner and outer condyle. 

These two bellies are triangular and much narrower above than 
below. Above there is an interval of about four inches, which is filled 
by an abundant and very loose cellular tissue and also by the vessels 
and the nerves of the leg. Their fibres converge from above downward 
and meet the common tendon a little above the centre of the whole 
length of the muscle. The upper tendon, which is expanded along 



MYOLOOT. 159 

the external edge and the posterior face, gradually becomes thinner 
and descends almost to the lower extremity of the fleshy belly. The 
latter terminates below in a rounded edge ; so that the two bellies unite 
and form a waved line, very concave in its central part. The inner 
belly is much stronger and descends much lower than the outer. The 
lower tendon, in which the two fleshy bellies are inserted, arises far 
above their anterior face, that which corresponds to the posterior face 
of the bones of the leg, from the union of the two bellies to the centre 
of their common lower edge : it forms a broad canal, through which 
pass the branches of the nerves and vessels which descend on the 
posterior face of the loose portion of the common tendon. 

The third belly, called also the solccus muscle, Tibio-calcanien, Ch., 
is much stronger than the two preceding. It is situated below and 
before them. 

It arises by its upper edge, which is fleshy, serrated, and oblique 
downward and inward, from the posterior part of the head of the 
fibula, from the lower edge of the poplitaeus muscle, and from the pos- 
terior edge of the tibia. Its lower edge and a part of its anterior face 
arise for a considerable distance above from the posterior face and below 
from the inner edge of the tibia. Finally, its outer edge comes from 
the upper part of the posterior face and from the outer edge of the 
fibula. 

Its posterior and upper fasciculi go directly downward. The ante- 
rior and inferior of the two sides meet each other below and are attached 
to the anterior face of the common tendon, covering its anterior face to 
some inches above its insertion, gradually becoming thinner and nar- 
rower, so that this belly consequently occupies nearly all the leg, and 
descends very much lower than its centre. 

The tendons by which the two lateral edges of this muscle arise 
from the fibula and the tibia gradually enlarge, descend on the anterior 
edge and on the posterior face, and do not stop except at some inches 
above the lower end of this fleshy belly. Hence most of the latter is 
enclosed between two aponeurotic expansions. 

The common inferior tendon, called the Achilles tendon ( tendo 
Achillis), from its power, is slightly covered above and behind by the 
two posterior bellies and before by the third belly. A little above the 
lower edge of the posterior bellies it divides into an anterior and a pos- 
terior tendinous layer. The latter reascends on the anterior face of the 
gastrocnemius in the manner mentioned above : the other covers the 
posterior face almost to the upper edge, gradually becoming thinner. 

The tendon, considered as a whole, contracts very much from above 
downward, and also becomes thicker, and is attached by a very narrow 
to the upper part of the posterior face of the tubercle of the cai- 
rn, between which and its anterior face we find a considerable 
mucous bursa above its insertion. 

The triceps extends the foot in raising the heel : hence why it acts 
principally in standing on the toes and other similar circumstances. 



160 DE8CRIPTIVE ANATOMY. 

When the foot is fixed, the two upper heads bond the knee and draw 
the thigh backward and downward. The lower head, when it con 
tracts toward the heel, extends the foot, because it carries the leg down- 
ward. 

This muscle corresponds to the supinators and to the pronator quad- 
ratus of the fore-arm : the two superficial heads represent the supina- 
tors and the deep head is analogous to the pronator. 

B. PLANTAHIS. 

§ 1240. The plantaris muscle, Petit femoro-calcanien, Ch., arises by 
a short tendon from the posterior face of the external condyle of the 
femur, from the external head of the gastrocnemius muscle, to which it 
is united, and from the posterior wall of the synovial capsule. Pro- 
ceeding directly behind the capsule, it goes inward and downward and 
even becomes a long, thin, and flat tendon, which descends along the 
inner edge of the tendo Achillis, unites with it below, and disappears in 
the cellular tissue on the inner face of the calcaneum to arrive at the 
tendinous expansion of the sole of the foot. 

This muscle has no very manifest action. We see in it only a rudi- 
ment of that which is much more developed in some mammalia and an 
imperfect imitation of the palmaris brevis of the hand. 

§ 1241. It is often deficient and much more frequently than the 
palmaris.(l) 

II. DEEP LAYER. 

§ 1242. The deep layer of the posterior muscles of the leg is com- 
posed of the poplitams, the tibialis posticus, the flexor longus digitorum 
communis, and the flexor longus pollicis proprius. 

A. POPLIT.EUS. 

§ 1243. The poplit&us muscle, Femoro-popliti-tibial, Ch. (M.popli- 
icbus, s. sub popliiaMs), is a triangular muscle, which arises from the 
inferior and posterior part of the outer face of the external condyle of 
the femur. Jt is formed of oblique fibres, becomes broader from without 
inward, and is attached to the upper part of the posterior face of the 
tibia. It is intimately connected, especially at its upper and outer 
part, with the posterior wall of the synovial capsule of the knee. We 
find a mucous bursa between it and the external condyle of the femur 
on one side, the external semilunar cartilage and the capsular liga- 
ment on the other. 

(1) Our observations authorize us to assert that Gantzer mistakes in stating that 
the plantaris is more constant than the palmaris (loc. cit., p. 4). 



MYOLOGY. 161 



This muscle corresponds to the pronator teres of the fore-arm. 
It turns the leg a little inward, draws the outer semilunar cartilage 
outward and backward, and contributes to bend the knee. 
§ 1244. Sometimes it is double.(l) 

B. TIBIALIS POSTICUS. 

§ 1245. The tibialis posticus muscle, Tibio-soas-tarsien, Ch. (JVf. 
tibialis, s. tibiozus ■posticus, s. nauticus), arises between the extensor 
digitorum communis longus and the flexor longus pollicis pedis 
(§ 1248). It is the longest of the three muscles of the deep-seated 
layer and is penniform. It arises in its whole length from most of the 
posterior face of the interosseous ligament and from the inner face of 
the fibula ; some fibres of its upper part arise also from the outer part 
of the posterior face of the tibia. 

Even as in the two long flexors of the toes, the two layers of fibres 
are attached to a very strong tendon, which descends inward and for- 
ward, is contained within the posterior and fibro-cartilaginous groove of 
the internal malleolus, thence passes into an analogous groove hollowed 
along the upper part of the inner face of the astragalus, and thus goes 
to the inner and lower face of the sole of the foot, opposite the anterior 
part of the inner face of the astragalus. Its tendon incloses a rounded 
sesamoid bone and divides into two slips : the internal is shorter, the 
inferior is longer. 

The first is single and is attached to the inner edge of the scaphoid 
bone. The second divides into several bands, which are inserted in the 
lower face of the scaphoid, the cuboid, and the three cuneiform bones, 
at the same time that they blend with the aponeurotic expansion of the 
sole of the foot and with the tendon of the peroneus longus. 

The tendon of this muscle is surrounded with a mucous sheath where 
it arrives at the sole of the foot. 

This muscle corresponds to the radialis internus muscle (§ 1149). 

It extends the foot, turns its inner edge a little upward, and the sole 
inward j it also extends the thigh and draws it backward. 

C. PLEXOR L0NGU3 DIGITORUM COMMUNIS. 

§ 1246. The flexor longus digitorum communis muscle, Tibio-pha- 
langettien, Ch., (JVf. flexor digitorum communis longus, s. perforans, s. 
profundus), is a thin, elongated, and penniform muscle; it arises from 
the summit of the anterior face of the tibia, except its upper part, which 
is covered by the poplitreus. The fasciculi, by which it arises, and 
which converge downward are inserted in a strong tendon below, which 
ascends almost to the upper extremity of the muscle and proceeds along 
the inner edge. This tendon approaches the surface, descends on the 

(1) Fabricius, De motu locali animalium, in Op., p. 359. 

Vol. II. 21 



162 DESCRIPTIVE ANATOMY 1 . 

posterior face of the tibia, goes to the inner face of the tarsus, and enters 
a fibro-cartilaginous furrow which exists along the upper part of the 
inner face of the astragalus, and is there kept in its position by a tendi- 
nous sheath, and thus goes forward. After leaving this point it turns 
outward, is covered by the posterior head of the abductor pollicis pedis 
muscle, on which it continues to go forward, and soon divides into four 
bands, which go in their turn on the flexor digitorum brevis, which 
is consequently covered by it. 

At the place where the tendon of the flexor longus muscle passes on 
the flexor brevis, and before it divides into four bands, we sec a small 
muscle attached to its external and inferior part. The form of this 
muscle is an oblong square. It may be called the small or accessory 
head of the flexor longus communis (accessorius perforanlis). 

This small head, which is covered on all sides by the flexor commu- 
nis digitorum brevis, arises by two slips, the posterior or external, which 
is longer and stronger and comes from the external anterior tuberosity 
of the calcaneum, and the anterior or internal, which is smaller and 
arises from the superficial calcaneocuboid ligament (§ 982). Its fibres 
arc oblique. It goes forward and inward, and not only is it fitted by 
its inner edge to the tendon of the flexor digitorum longus, but contri- 
butes much by its anterior tendons to form those of this muscle. 

The small head principally forms almost the whole tendon of the 
second toe. Most usually this tendon is not at all derived from that of 
the slip of the common flexor, but only from the short head and from 
the tendon of the extensor longus proprius pollicis, with which the centre 
of the flexor communis communicates near the anterior extremity of 
the calcaneum. 

The tendons of this muscle have the same relation to those of the 
short flexor as those of the flexor digitorum sublimis have with those of 
the flexor profundus. They are situated upon them, perforate them 
above the second phalanx of the toes, enlarge a little, and are attached 
to the posterior part of the lower face of the third phalanges. 

It is surrounded by a mucous sheath in the place where its tendon 
passes at the side of the fibula and of the calcaneum. A second enve- 
lops this tendon and that of the flexor longus pollicis proprius at the 
posterior extremity of the sole of the foot. 

The tendon it gives to each toe and that of the flexor minimi digiti 
proprius are surrounded with a proper mucous sheath. 

This muscle bends the third phalanx of the toes and brings the leg 
backward. 

§ 1247. Sometimes it is furnished with a fifth tendon, which replaces 
the fourth of the flexor digitorum brevis, which is then deficient. This 
tendon proceeds along the inner edge of the fourth tendon of the flexor 
longus, and divides to allow the latter to pass, and consequently pre- 
sents the same arrangement as the flexor sublimis.(l) This formation 

(1) Brugnone, loc. cit., p. 176. 



MYOLOGY. 163 

evidently resembles that of the apes, in which the tendons of the flexor 
sublimis and flexor profundus are so blended that they are distinguished 
from each other with difficulty. 

D. FLEXOR LONGUS POLLICIS FKOFRItiS. 

§ 1248. The flexor longus pollicis proprius muscle, Peroneosous- 
phalangettien du pouce, Ch. (JVI. flexor hallucis longus), is shorter but 
much stronger than the preceding. It arises by an internal and an 
•external layer of fibres, which converge downward and proceed by 
fleshy fibres from almost all the lower half of the posterior face and 
from the outer edge of the fibula, excepting only its lowest portion. 
These two orders of fibres are inserted in a strong lower tendon, which 
mostly remains concealed in the midst of the muscular substance and 
becomes entirely loose only when its fleshy fibres cease. This tendon 
goes obliquely from without inward and from behind forward, and thus 
comes on the inside of the tarsus, whence it goes forward along a fibro- 
cartilaginous groove, which exists at the upper part of the inner face of 
the calcaneum, directly below the upper edge of this bone, and where 
it is retained by a special sheath. It is covered by the outer slip of the 
posterior head of the abductor pollicis pedis muscle and directly by 
the tendon of the flexor communis digitorum longus which is nearer 
the surface, and is consequently situated beneath it. It crosses the 
direction of the latter and sends to it a very strong tendon, which unites 
principally to that of the second toe. 

We may justly say that the tendon of the flexor longus pollicis pro- 
prius muscle divides into two slips where it passes under the abductor 
pollicis pedis, an external for the second toe and an internal for the 
large toe. The latter is the strongest ; it goes inward and forward 
directly at the side of the abductor pollicis pedis, is situated outward 
before it, and is partly covered by it. At the anterior end of the meta- 
tarsal bone of the large toe it enlarges a little, at the same time be- 
comes thinner, and is attached to the posterior part of the lower face 
of the second plialanx of the large toe. 

This muscle corresponds to the flexor longus digitorum communis 
in its course and in its attachment to the anterior phalanx of its toe. 

There is in fact a short flexor of the large toe ; but this muscle has 
no perforated tendon which is attached to the posterior phalanx. On 
the contrary, we sometimes see an arrangement analogous to that of 
the tendons of the flexor brevis perforatus. In fact a strong but nar- 
rower tendon, which however gradually enlarges as it advances, ex- 
tends from the head of the first metatarsal bone to the posterior end of 
the second phalanx, over the tendon of the flexor longus : this tendon 
is firmly attached in its whole extent and breadth of its upper face to 
the lower face of the phalanges, by a fold of the synovial capsule : it 
contains a single and transverse sesamoid bone : immediately behind its 
anterior extremity and below the articulation of the first phalanx with 



164 DE8CIUPTIVE ANATOMY. 

the second, it is finally attached to the lower face of the first phalanx, 
directly behind the tendon of the flexor longus. 

This tendon which has no muscle, is not found in the other toes ; so 
that decidedly we should consider it as a rudiment of the flexor l< 
communis perforatus ; it is however but an imperfect rudiment, since it 
is never perforated, which depends probably on the absence of the 
second phalanx of the large toe. 

The tendon of this muscle is enveloped with a mucous bursa in the 
canal of the astragalus and os calcis. A second covers its tendon and 
that of the flexor longus at the posterior part of the sole of the foot. A 
third incloses its tendon along the metatarsal bone of the first toe. 

It flexes the large and small toe. 

§ 1249. We sometimes find at the lower part of the posterior face of 
the leg a small supernumerary muscle, which does not always present 
exactly the same arrangement. Sometimes it ascends from the cal- 
caneum and from the tendo Achillis, and is attached to the aponeurotic 
expansion of the leg, acting as its tensor muscle ;(1) so that we may 
then consider it as a fourth head of the triceps. It sometimes arises 
from the lower part of the fibula, goes downward, and is then lost 
around the articulation of the foot. It is sometimes attached to a spe- 
cial bone found in this place,(2) or to the lower face of the calcaneum, 
or finally to the small head of the flexor longus digitorum communis. (3) 

The second anomaly is very probably a repetition of the pronator 
quadratus of the upper extremity, but it is developed lower toward the 
foot, in accordance with the same law as that to which the other mus- 
cles are subjected, especially the flexors and extensors of the toes. 

The first corresponds probably to the palmaris brevis ; the arrange- 
ment of the muscle in the upper and lower extremity differ in the same 
way as the palmaris brevis and the plantaris, as the latter does not 
arrive at the aponeurotic expansion of the sole of the foot. 

II. EXTERNAL MUSCLES. 

§ 1250. The external muscles of the leg are the peroneus longus 
andthe peroneus brevis. They extend from the fibula to the outer 
edge and to the lower face of the foot. 

I. PERONEUS LONGUS. 

§ 1251. The peroneus longus muscle, Peroneo-sous-tarsien, Ch. (JVf. 
peroneus longus, s. primus, s. posticus), arises from the upper and smaller 
half of the anterior face, and by fibres which proceed obliquely from 
above downward and converge. Its upper tendon arises from the outer 
edge of the fibula and covers the upper and posterior part of this bone. 

(1) Mayer in Heymann, loc. cit., p. 15. 

(2) RosenmtUler, loc. cit., p. 8. 

(3) Gantzer, loc. cit., p. 15-17. 



MYOLOGY. 165 

The lower tendon, which is very long, very strong, flat, and entirely 
loose from the lower third of the leg, conceals itself partially above this 
point between the muscular fibres ; so that it entirely disappears exter- 
nally toward the bottom of the upper third of the leg. But it appears 
again within the muscle, near its upper extremity, as a semicircular 
band, which gradually diminishes and to which the fleshy fasciculi are 
attached outward and inward. 

This tendon goes behind and on the outside of that of the peroneus 
brevis, along the outer and posterior face of the leg, and descends be- 
hind the external malleolus across a ligament formed of oblique fibres, 
within which is a sheath which sends prolongations to it. Arrived at 
the foot, the tendon winds forward and down\vard,'around the outer edge 
of the cuboid bone, and thus comes on the sole of the foot, where it pene- 
trates ; thence it goes inward, covered by all the muscles of this region 
and directly by the calcaneo-cuboid ligament, which keeps it in place : 
then gradually enlarging, it is attached to the lower face of the cuboid 
bone and also to the lower face of the posterior head of the fifth, also of 
the fourth and third, and particularly of the second metatarsal bones : 
it sometimes also reaches the first metatarsal bone and the first cunei- 
fornf bone before dividing. 

At the place where the friction of the tendon is the greatest, espe- 
cially opposite the external malleolus, the tuberosity of the calcaneum, 
and the cuboid bone, sometimes also in its plantar portion, we find sesa- 
moid bones or cartilages, the third of which is the largest, while the 
first is very small and often scarcely perceptible. 

There is also a considerable mucous bursa where the tendon of the 
muscle descends on the outer malleolus and astragalus : this bursa en- 
velops it and also the tendon of the following muscle. We find another 
below, which extends to the plantar face. 

The peroneus longus muscle extends the tibio-tarsal articulation and 
draws the foot backward and the leg downward : it also turns the foot, 
making its outer edge the upper and the plantar face look upward. 

It corresponds to the flexor carpi ulnaris of the fore-arm. 

II. PEBONEUS EEEVIS. 

§ 1252. The peroneus brevis muscle, Grand peroneo-sns-metatarsien, 
Ch. (JW. peroneus, s.ftbularis brevis, s. anticus, s. secundus, s. medins, 
s. semifibidmis), is an elongated muscle, which terminates above in a 
point and is formed of two layers of fibres ; those of the anterior layer 
go from before backward and those of the posterior go from behind for- 
ward. These two layers converge toward the base : they arise from 
the second fourth of the anterior face and from the posterior edge of 
the fibula to near the outer malleolus. 

The lower tendon, which is long, strong, and flat, extends within 
the muscle, and like that of the preceding ascends almost to its upper 
extremity. It becomes visible externally sooner than that of the pero- 



166 DESCRIPTIVE ANATOMY. 

neus Iongus, and descends between the fibres of the muscle to arrive 
at its outer face. 

Once disengaged it goes before that of the peroncus Iongus, behind 
the outer malleolus, and is retained in the groove which exists there by 
a ligament, common to it and the preceding muscle. This ligament, 
called the retinaculum musculorum peronceorum, extends from the ante* 
rior to the posterior edge of the groove like a bridge. The tendon 
having thus reached the upper face of the foot goes forward; enlarging 
along its anterior edge. Near the base of the fifth metatarsal bone it 
usually divides into two slips, the outer of which is attached to the 
tuberosity of this bone while the inner is longer, subdivided likewise into 
two parts, one of which is attached to the centre of the upper face of 
its body ; the second is inserted partly in the outer edge of the fourth 
tendon of the extensor and partly on the posterior face of the fourth 
external interosseous muscle. 

Besides the common mucous bursa (§ 1229) the tendon of this mus- 
cle has a special bursa situated lower on the outer edge of the foot, 
and which surrounds it. 

The peroneus brevis muscle acts like the preceding ; it flexes the 
tibio-tarsal articulation, consequently carries the foot upward, and 
depresses the leg ; it also turns the sole of the foot outward and its 
outer edge upward, but less so than the peroneus Iongus. 

It corresponds to the extensor carpi ulnaris, and paitially also to the 
extensor brevis minimi digiti. 

§ 1253. It is sometimes double. 

III. ANTERIOR MUSCLES. 

§ 1254. On the anterior face of the leg we find one after another 
the extensor Iongus digitorum communis, the extensor Iongus hallucis 
proprius, and the tibialis amicus. 

I. EXTENSOR LONGUS DIGITORUM COMMUNIS. 

§ 1255. The extensor Iongus digitorum communis muscle, Peroneo- 
sus-phalangettien commun, Ch. (J\I. extensor digitorum communis Ion- 
gus), is a very long muscle,, occupying almost all the leg. Its fibres 
descend obliquely from behind forward. It arises above from the outer 
face of the head of the tibia, and, in the rest of its course, from the 
anterior face of the interosseous ligament, and also from the anterior 
edge of the fibula. It is attached to the tendon which commences 
near its upper extremity and which descends on its anterior edge. 

This tendon generally divides below the crucial ligament of the foot 
into five slips, which separate from each other. The outer is the 
shortest, and is inserted into the posterior extremity of the upper face 
of the fifth, and sometimes also of the fourth, metatarsal bone. This 
slip is sometimes connected with a special fleshy belly entirely distinct 



MYOLOGY. 167 

from the extensor longus,but which most generally forms only the lower 
part, and which is called the small or the peroneus tertius muscle. It 
is not infrequently deficient, and is then replaced to a certain extent by 
the inner part of the tendon of the peroneus brevis muscle : it 
also frequently forms a small special tendon which is sometimes 
attached forward to the metatarsal bone, and sometimes unites either 
to the fourth external interosseous muscle or to the tendon sent by the 
common extensor to the fifth toe. The four other slips go obliquely 
forward and outward ; they are attached to the dorsal faces of the 
second, third, fourth, and fifth toes. Arrived at the base of the poste- 
rior phalanges they become broader and a little thinner, and give off 
also, the fourth outwardly, the other three inwardly, a thin triangular 
prolongation, formed of perpendicular fibres, which go downward, and 
are attached partly to the base of the first phalanx, and are partly 
blended with the tendon of the interosseous muscles. 

This tendon sometimes assumes the nature of cartilage when pass- 
ing over the synovial capsule of the first phalangean articulation. On 
the articulation between the second and third it enlarges or divides 
more or less completely into two lateral slips, which converge forward, 
and after uniting are attached to the upper face of the third phalanx, 
directly before its posterior edge. 

We find an oblong mucous bursa on the articulation of the foot, 
between the tendon of this muscle and the capsular ligament. 

The extensor digitorum communis longus raises the four smaller 
toes, extends them, and with the peroneus brevis muscle, bends the tibio- 
tarsal joint, and thus raises the foot or draws the leg forward and down- 
ward. 

This muscle and the preceding act principally in standing on the 
toes, because they fix the leg. 

The extensor digitorum communis longus corresponds to the com- 
mon extensor of the fingers. The proper extenso 1- of the little finger 
is represented by the peroneus tertius, and when that is deficient by a 
part of the peroneus brevis. 

This analogy becomes still more evident when the portion of the 
flexor longus belonging to the little toe, and the peroneus tertius muscle, 
are entirely separated from the rest of the muscle.(l) 

II. EXTENSOR LONGUS HALLUCIS PnOPRIUS. 

§ 1256. The extensor longus hallucis proprius muscle, Peroneo sus- 
phalangettien du pouce, Ch., is a thin and semipenniform muscle, which 
arises, by fleshy fibres, from the lower two thirds of the inner face of 
the fibula, and from the anterior face of the interosseous ligament. It 
also receives below some fibres from the outer face of the tibia. 

Its fasciculi are attached to a tendon which proceeds along the 
anterior edge of the muscle, gradually becomes broader, passes across 
a particular groove of the crucial ligament of the back of the foot, goes 

(1) Brugnone, loc. tit. — We have Been it several times. 



1C8 DESCRIPTIVE ANATOMY. 

inward and forward along the inner edge of the tarsus, and is attached 
to the upper face of the unguaeal phalanx of the first toe. 

On the back of the tibio-tarsal articulation the tendon of this muscle 
is inclosed in a special mucous sheath. 

It raises all the first toe. 

§ 1257. This muscle is often more or less completely double. In 
this case we sometimes find another which is smaller, and which arises 
more externally from the fibula, and from the anterior face of the inter- 
osseous ligament, goes to the large toe, and unites to the tendon of this 
muscle, or _is attached to the first metatarsal bone, or finally loses 
itself in the cellular tissue. Sometimes and most generally another 
smaller tendon is detached, even in the leg, from the inner edge of the 
normal tendon, which is inserted in the tibial side 6f the two phalanges. 
These anomalies are important because they approximate the forma- 
tion of the proper extensor of the large toe to that of the proper exten- 
sor of the thumb ; so too on the other hand, the deficiency of the short 
extensor of the thumb, or its blending with the large, approximates the 
formation of the hand to that of the foot. 

III. TIBIALIS ANTICUS. 

§ 1258. The tibialis anticus muscle, Tibio-sus-tarsicn, Ch. {M. tibi- 
alis, s. tibiceus anticus, s. catena musculus, s. hippicus), is the strongest 
of the three anterior muscles of the leg ; it arises directly at the side of 
the peroneus longus muscle, and is covered in this place by a broad 
tendon, which expands on its anterior face from the lower face of the 
outer part of the head of the tibia, and still lower from the outer face 
of this bone, nearly to its lower third, so that its fibres gradually come 
only from the most posterior portion, and even the inner edge of this 
face in all its course. At the same time it receives some which arise 
from the periosteum. All these fibres, which go obliquely forward, 
are attached to an anterior tendon, which is loose only in a very small 
point of its extent downward, but which extend within the muscle 
even beyond its centre. This tendon, which is very strong, descends 
obliquely inward, passes on the anterior face of the tibio-tarsal articu- 
lation, comes upon the inner edge of the foot, where it is retained by a 
ligamentous band, oblique downward and backward, which extends 
from the scaphoid to the first cuneiform bone, and is finally attached 
by two short slips to the inner part of the lower face of the large cune- 
iform bone,' and also to the base of the metatarsal bone of the large toe. 

Opposite the articulation of the foot its tendon is enveloped in a 
mucous sheath. 

It raises the foot, turns it on its axis, so that its sole looks inward 
and its inner edge upward. 

It corresponds to the radiales muscles of the hand. 



MYOLOGY. 169 

ARTICLE FIFTH. 

MUSCLES OF THE FOOT. 

§ 1259. The muscles of the foot arise from the tarsus and metatarsus, 
and are all attached to the phalanges of the toes. They are situated 
on the back of the foot, on its sole, on its internal and external edges. 
Some are common to several toes, others belong exclusively to some 
of them, namely to the large and small toes. The latter are only 
repetitions of those which are divided between several of them. 

I. MUSCLES OF THE BACK OF THE FOOT. 

§ 1260. Besides the tendons of the extensor digitorum communis 
longus and of the two peronei muscles, we find also on the back of 
the foot the extensor communis digitorum brevis. 

EXTENSOR COMMUNIS DIGITORUM BREVIS. 

§ 1261. The extensor communis digitorum brevis muscle, Calcaneo- 
sus-phalangettien commun, Ch. (JVf. extensor digitorum pedis communis 
brevis, s. pediazus externus), is a flat muscle, formed of four elongated and 
rounded bellies, which arises from the back of the anterior process of 
the calcaneum, goes forward and inward, its bellies separating from 
each other, and is attached by four tendons to the four inner toes. 
These tendons in their course on the metatarsus cross those of the 
extensor communis digitorum longus, but on the toes they are situated 
on the outside of them. The outer three are very intimately blended, 
by their internal edge, with the outer edge of the tendons of the 
extensor longus, and consequently form their outer half; but the 
most internal, that which goes to the great toe, does not unite to the 
corresponding tendon of the flexor longus, but is attached below it to 
the posterior edge of the back of the first phalanx of the large toe. 

This muscle extends the four inner toes and directs them a little 
outward. 

§ 1262. Often and even most generally its inner belly is separated 
much more from the others than the latter are from each other. Very 
frequently it forms an entirely distinct muscle, which deserves to be 
noted because of the more striking resemblance established between 
the upper and lower extremities by this peculiarity. Sometimes the 
other bellies and even all are entirely detached from each other, a 
curious analogy with what exists in birds. Again, the extensor brevis 
often presents supernumerary bellies. Most commonly a small fleshy 
fasciculus exists between the internal and what is commonly called 
the secon 1 ; its tendon is attached either to the second metatarsal bone 
or to the tibial face of the second toe. This accessory muscle, men- 

Vol. II. 22 



170 DESCRIPTIVE ANATOMY. 

tjoned by Albinus,(l) and which we have often seen, is curious, ns it 
must evidently be considered as a repetition of the indicator muscle. 

The second belly is also sometimes divided at its anterior extremity 
into two fasciculi, or sends two tendons to the second toe. 

The tendons of the third and fourth bellies are often divided, so that 
there is for the third toe an extensor muscle or at least a tendon ; this 
arrangement resembles the doubling of the proper extensor of the 
index finger in the hand for a proper extensor of the third finger. 

After this anomaly the one most frequently found consists in the 
presence of a small special belly for the fifth toe. We have also seen 
this several times, and it is interesting as an analogy either with the 
apes(2) or with the extensor proprius minimi digiti. 

II. MUSCLES OF THE SOLE OF THE FOOT. 

§ 1263. Most of the muscles of this part of the lower extremity are 
found in the sole of the foot.(3) In fact, besides the short head of the 
extensor digitorum communis already described (§ 1245), we find the 
flexor communis digitorum brevis, the adductor and flexor of the large 
and little toes, the adductor hallucis, the lumbricales, and the interossei 
muscles. 

The adductor hallucis occupies the inner edge of the foot and that 
of the little toe the outer edge. A great part however of these muscles 
project likewise in the sole, so that it is best to study them at the same 
time as the other muscles of the toes, to which they belong, and to 
consider them as the lower muscles of the foot. 

We shall describe first the common muscles, next the special mus- 
cles : first, however, their common aponeurosis. 

I. PLANTAH APONEUROSIS. 

§ 1264. The plantar aponeurosis (aponeurosis plantaris) is a very 
firm tendinous layer, formed of longitudinal fibres, which arises from 
the lower face of the tuberosity of the calcaneum, directly under the 
skin, with which it is intimately connected. Thence it goes forward, 
where it enlarges very much. Arrived at the anterior edge of the 
metatarsus it divides into five slips, which correspond to the five toes, 
and which are attached to each other by transverse fibres. 

This aponeurosis protects and fixes the muscles of the sole of the 
foot, and at the same time increases the surfaces of insertion of several. 

(1) Hist, muse, p. 602. 

(2) Meckel, Beytragc zur vergleichenden Anatomic, vol. ii. part i. 

(3) A. F. Walther, Tractationes dc articulis, ligamcntis et musculis inccssu diri- 
gendis supplementum tabulamque noram plantce humarti pedis exhibens, Leipsic, 
1731.— D. C. de Courcelles, Icones musciUorum plantce pedis, sorumque descriptio, 
Amsterdam, 1760. 



MYOLOGY. 171 



II. COMMON MUSCLES OF THE SOLE OP THE FOOT. 

a. Flexor digitorum pedis communis brevis. 

§ 1265. The flexor communis digitorum brevis muscle, Calcanco- 
sous-pkalanginicn commun, Ch. (J\I. flexor digitorum pedis communis 
brevis, s. perforatus, s. sublimis, s. pediazus interims), is elongated, 
quadrilateral, thicker behind, and broader but thinner before. It arises 
by very strong tendinous fibres, which extend on a considerable portion 
of its lower face from the lower face of the tuberosity of the calcaneum, 
and by fleshy fibres by almost all its lower face, from the upper 
face of the plantar aponeurosis, to which its posterior tendon al^o 
adheres. Posteriorly it is very intimately united internally with the 
outer edge of the adductor pollicis, and above with the short head of 
the extensor communis digitorum longus. Nearly in the centre of the 
sole of the foot it divides into four very short fleshy fasciculi, which soon 
become as many single tendons. The latter are attached to the 
second^ third, fourth, and fifth toes. They cover those of the extensor 
longus and are much smaller. They are arranged in the same manner 
anteriorly as those of the extensor digitorum sublimis. In fact a 
rhomboidal fissure begins a little before the posterior extremity of the 
first phalanx, which extends to before the centre of this bone. The 
tendons of the extensor communis digitorum profundus pass through 
these fissures. 

The two halves of the tendon which pass through this division 
unite for a short extent ; then again separate, enlarge and diverge from 
before backward, and are separately attached by straight edges to 
the centre of the lower face of the second phalanx. 

Each tendon of this muscle is attached with the corresponding 
tendon of the flexor longus, to the lower face of the toes by synovial 
and fibrous ligaments, exactly like those which retain the tendons of 
the flexor sublimis and profundus of the fingers. 

This muscle flexes the first and second phalanges of the four outer 
toes. 

§ 1266. The fourth tendon is sometimes deficient, and then it is 
often but not always replaced by a tendon of the flexor longus. In 
some subjects there seems to be an antagonism between the short 
extensor and the short flexor of the toes ; for we have sometimes found 
in this case the number of tendons of the second is greater than usual. 

Sometimes also another portion of the muscle is deficient ; it is 
usually the most internal or the most external. It is then replaced by 
other fasciculi which come from the flexor of the large and that of the 
little toe, which reminds us of the insulation of the internal head of 
this muscle in apes, and the disappearance of the short common flexor 
as a separate muscle in all the other mammalia and in all birds. 



172 DESCRIPTIVE ANATOMY. 



b. Lumbricalcs. 

§ 1267. The lumbricales muscles, PlanU-sous-phahingiens, Ch., 
correspond to those of the hand in number, form, and situation. They 
arise by fleshy fibres from the tendons of the flexor digitorum longus, 
and are attached, partly by short tendons, to the posterior head of the 
first phalanx of the four outer toes, and partly by thin tendinous ex- 
pansions, to the tendons of the extensor digitorum longus. 

c. Interossei. 

§ 1268. We find in the foot as in the hand seven interossei muscles, 
JMetatarso-phalangiens laleraux, Ch. (JVf. interossei), which fill the 
intervals between the metatarsal bones. They arise from the posterior 
part and from the lateral faces of these bones, and their anterior tendons 
blend below with those of the extensor communis. 

We distinguish them into external and internal. The first are four 
and the second three in number. 

a. External interossei. 

§ 1269. The upper and external or dorsal interossei muscles (M. 
interossei externi, s. supcriores, s. dorsales) are situated directly below 
the extensor communis digitorum brevis, in the first, second, third, and 
fourth interosseous spaces. 

The first, which is the most internal, differs from the other three in 
its form and arrangement. In fact it comes only from the tibial side 
of the second metatarsal bone and is attached forward by a short, broad, 
and flat tendon to the inside of the first phalanx of the second toe. 

It is however almost always divided into two heads, the upper of 
which is longer and much thinner than the lower. 

The second, third, and fourth have two heads each, which are in- 
serted by short tendons on the outer or fibular side of the first phalanx 
of the second, third, and fourth toes. 

The outer head is much larger, arises from the posterior part of the 
inner face of the metatarsal bone, which is placed directly on the out- 
side of the toe to which the tendon is attached, and descends as deeply 
as the internal, on the side of the sole of the foot. The inner is the 
smallest, and arises from the posterior part of the outer face of the me- 
tatarsal bone of the toe in which its tendon is inserted, and descends a 
little lower than the preceding. The fibres of these two heads unite at 
a very acute angle and are implanted in a common tendon. 

The first external interosseous muscle brings the first toe inward ; 
the second, third, and fourth carry the toes to which they are attached 
outward. 



MYOLOGY. 173 



ft. Internal interossei. 



§ 1270. The internal, inferior, or plantar interossei muscles (JVf. 
interossei interni, s. inferiores, s. plantares) are smaller than the exter- 
nal and have only one head. They arise from almost all the posterior 
part of the inner or tibial face of the third, fourth, and fifth metatarsal 
bones, and are attached by a considerable tendon to the inner face of 
the first phalanx of the third, fourth, and fifth toes. This tendon is 
closely united to the capsule of the metatarso-phalangean articulation, 
and sends a prolongation to that of the extensor communis. 

These muscles direct the third, fourth, and fifth toes inward toward 
the large toe. 



III. PROPER MUSCLES OF THE TOES. 



§ 1271. We may consider as proper muscles those of the large and 
small toes. 

a. Muscles of the large toes. 
a. Abductor ballucis. 

§ 1272. The abductor hallucis muscle, JVLetatarso-sous-phalangien 
dv, premier orteil , Ch., is the strongest short muscle of this toe. It 
arises by several slips from the inside of the tarsus and the metatarsus, 
and is attached to the inside of the large toe. To simplify the descrip- 
tion, we may refer these several slips to two heads. 

The posterior head, which is the larger, arises by two bands, of 
which the inferior is longer, from the lower part of the inner side of the 
tuberosity of the calcaneum, and the upper, which is shorter, from the 
upper and projecting part of the inner face of the body of the calca- 
neum. 

The anterior head, which is the smaller, arises by three or four dis- 
tinct slips from the inner and anterior face of the astragalus, scaphoid, 
the first cuneiform, and first metatarsal bone. The posterior tendon of 
these two fasciculi covers them from their origin to near their anterior 
extremity below. The anterior, which is much stronger, begins near 
the centre of the posterior belly and is situated on its inner side ; so that 
the fibres of the two bellies which go forward and inward are inserted 
at acute angles. 

This last tendon, after it disappears from the surface, extends very 
far within the muscle, whence it goes backward and divides into seve- 
ral very considerable slips. Anteriorly, it is sometimes attached by two 
slips to the lower and inner face of the head of the first metatarsal 
bone, to the inner face of the capsular ligament of the first me- 
tatarso-phalangean articulation, and principally to the inner and lower 



174 DESCRIPTIVE ANATQMV. 

part of the base of the first phalanx of the large toe, where it adheres 
intimately to the flexor digitorum brevis. 

This muscle brings the large toe inward and flexes it a little. 

b. Flexor brevis pollicis pedis. 

§ 1273. The flexor brevis pollicis pedis, Tarso-sous-phalangien ih 
premier orteil, Ch. (M. flexor hallucis proprius brevis), is much shorter 
than the abductor. It arises behind from the tendinous sheath of the 
peroneus longus, intimately united to the long head of the adductor of 
the large toe. Most generally its posterior extremity may be divided 
into an external and an internal belly. Thence it goes inward and 
forward. It is attached by a short tendon, more or less divided, to the 
posterior part of the lower side of the base of the first phalanx of the 
large toe. This tendon is generally united to that of the adductor out- 
ward ; it contains anteriorly, below the two parts of the head of the 
first metatarsal bone, two sesamoid bones placed one at the side of the 
other. 

This muscle flexes the first phalanx of the large toe. 

c. Adductor pollicis pedis. 

§ 1274. The adduct or pollicis pedis muscle, Calcaneo-sous-phalan- 
gien du premier orteil, Ch. (JVL, adductor hallucis), is a considerable 
muscle which has two bellies. 

The posterior is much stronger than the other and is placed above 
and outside of the flexor brevis pollicis pedis. It arises from the lower 
side of the base of the third and fourth and also often of the second me- 
tatarsal bone, and from the sheath of the peroneus longus, above the 
flexor brevis pollicis pedis. Before, on its outer and lower face, are 
strong tendinous expansions, which unite to give rise to the anterior 
tendon. This latter is united to the external tendon of the flexor brevis 
(§ 1212), and is attached to the outer face of the base of the first meta- 
tarsal bone. 

The anterior head is much smaller and weaker than the posterior, 
and arises from the lower and inner face of the capsular ligament, be- 
tween the metatarsal bone and the first phalanx of the fourth and fifth 
toes, sometimes also from the anterior part of the fifth metatarsal bone. 

It goes obliquely forward and inward, directly below the anterior end 
of the interossei muscles, between these and the tendons of the flexor 
communis digitorum profundus. It is attached by a thin and short 
tendon to that of the abductor of the great toe. 



MYOLOGY. 175 

b. Muscles of the little toe. 
a. Abductor minimi digiti. 

§ 1275. The abductor minimi digiti muscle, Calcaneo-sous-phalan- 
genien du petit orteil, Ch. (JVjT. abductor digiti quinti), is the longer of 
the two muscles of this appendage, has two bellies like the abductor 
pollicis pedis ; the posterior belly is greater. 

The posterior belly is covered below and behind by a strong aponeu- 
rosis, and arises from the posterior and from a little of the anterior part 
of the lower face of the tuberosity of the calcaneum. 

The anterior belly comes from the lower edge of the tuberosity of 
the fifth toe. 

Both are attached outwardly to a broad and strong tendon, which 
extends far back into the substance of the muscle and which is attached 
to the outer part of the lower face of the base of the first phalanx. 

b. Flexor minimi digiti brevis. 

§ 1276. The flexor minimi digiti brevis muscle, Tarso-sous-phalan- 
gien du petit orteil, Ch. (JW. flexor digiti quinti proprius brevis), is 
much smaller than the preceding. It arises from the inner part of the 
lower side of the base of the fifth metatarsal bone and from all the lower 
face of its body. It may almost always be divided into an outer and 
inner belly. Most frequently also it is attached by two distinct tendons 
to the inner part of the lower side of the base of the first phalanx. 

§ 1277. The muscles of the large and small toes may be referred to 
the other muscles of the foot, as we have seen those of the thumb and 
little finger could be to the other muscles of the hand. The abductor 
pollicis pedis is the first external interosseous muscle, and the posterior 
belly of the abductor the first internal interosseous muscle. The ante- 
rior belly of the latter represents the first lumbricalis. The flexor bre- 
vis digitorum pedis muscle corresponds to the flexor digitorum com- 
munis. The abductor minimi digiti is the last external interosseous 
muscle. Finally, the flexor minimi digiti brevis may be considered as 
belonging to the flexor digitorum communis, because of the slight de- 
velopment of the fourth tendon of the latter in most subjects. 

COMPARISON OF THE MUSCLES OF THE DIFFERENT REGIONS OF THE 

BODY. 

§ 1278. We have already compared the muscles of the different 
regions of the body with each other in different directions, while de- 
scribing each one particularly. They also conform to the law that the 
analogy betweeen the upper and lower halves of the body is more 
marked than that between the anterior and posterior. In fact we ob- 
serve, 1st, that many muscles which succeed from above downward 



176 DESCRIPTIVE ANATOMY. 

are repetitions of one another, as is evident with those between the 
vertebrae or between these bones and the head ; 2d, the muscles of the 
limbs correspond very evidently, and the differences they present, like 
those between the bones and the ligaments, depend on the greater 
solidity of the lower limbs and the greater mobility of the upper, either 
when considered as a whole and in their relations with the trunk, or 
when viewed in detail and in regard to the relations of their different 
parts with each other. An abnormal arrangement of the muscles 
belonging to the two extremities frequently renders their similitude 
more perfect and more evident than it is generally ; and if we do not 
err, of all the organic systems, the muscular most frequently presents 
anomalies in the configuration, which cause an unusual similitude be- 
tween the anterior and posterior faces of the body and also between its 
upper and lower portions. 

In this respect we often find an anterior sternal muscle, which de- 
termines a resemblance between man and animals, and the existence of 
which is so curious in another respect ; and we not unfrequently find a 
short head of the biceps flexor cubiti and a short extensor of the middle 
finger. 

So too the muscles of the lower limbs are frequently repetitions of 
those of the upper. The latter however seem to us more disposed to 
present assimilating anomalies in their configuration, which probably 
depends on a general law, amply supported by the vascular system, 
viz. that anomalies in the pelvic members are more frequent than in 
the pectoral extremities. 

GENERAL REMARKS ON THE MOTIONS OF THE HUMAN BODY. 

§ 1279. Having described successively the different organs of loco- 
motion, we must now briefly examine the principal motions(l) which 
result from their joint action. 

We must first endeavor to prove that the erect posture on the lower 
limbs is natural to man. 

A. ERECT POSTURE. 

I. OSSEOUS SYSTEM. 

§ 1280. We may also point out in this place the conditions which 
arise from the other organic sj'stems, not yet described, and which refer 
to the general form of the body, because the osseous system serves as 
the basis for all the others. 

In considering the body from below upward, we discover successively 
in the osseous system all the conditions which render the erect posture 
natural to man. 

(1) F. Roulin, Recherches theoriques et experimcntales sur le mecanisme dcs mouve- 
ments et dcs attitudes dans I'homme ; in the Journ. de physiol. cxp., vol. i. p. 209, 301, 
vol. ii. p. 45, 156, 283. 



MYOLOGY. 177 



I. In the lower extremities. 

§ 1281. 1st. The predominance of the bones of the lower over those 
of the upper extremities. 

2d. It is only in the erect posture that the articular surfaces of all the 
bones are exactly fitted to each other. 

3d. The breadth of the foot. 

4th. The size of the tarsus and metatarsus in proportion to the toes. 

5th. The number and size of the sesamoid bones. 

6th. The union of the bones of the leg with the tarsus at a right 
angle. 

7th. The length and the obliquity of the neck of the femur. 

8th. The breadth, concavity, and lowness of the iliac bones. 

2. In the trunk. 

§ 1282. 1st. The lowness, breadth, and curve of the sacrum, and 
also the curving inward of the coccyx, upon which and also on the 
arrangement of the iliac bones the peculiar shape of the human pelvis 
depends, which seems well adapted only for the erect posture. 

2d. The breadth and lowness of the vertebrae. 

3d. The considerable curve of the ribs, whence results the breadth 
and convexity of the thorax. 

3. In the head. 

§ 1283. 1st. The anterior, posterior, and horizontal position of the 
condyles and foramen magnum of the os occipitis. 

2d. The direction of the cavities of the orbits and nose forward in the 
erect posture and downward in that on the four limbs. 

4. In the upper limbs. 

§ 1284. 1st. The shortness and feebleness of these members in pro- 
portion to the lower. 

2d. The forced position of the bones of the fore-arm and of the radio- 
carpal articulation in walking on all fours. 

3d. The mobility of the radius. 

4th. The concavity and breadth of the bones of the metacarpus and 
of the phalanges. These latter circumstances indicate that the bones 
of the upper extremities are intended to grasp external objects, while 
the corresponding parts of the lower limbs prove they are designed 
to support the body. 

Vol. II. 23 



178 DESCRIPTIVE ANATOMY. 



II. LIGAMENTOUS SYSTEM. 

§ 1285. The peculiarities of the ligamentous system are as follow : 
1st. The ligaments of the lower extremities are stronger than those 

of the upper, and tins strength increases progressively from below 

upward. 

2d, The looseness of the cervical ligament, although the head is 

very much developed, in regard to the occipital foramen which is 

situated farther forward. 

III. MUSCULAR SYSTEM. 

§ 1286. The muscular system also furnishes several strong argu- 
ments : 

1st. The greater power of the muscles of the lower extremities. 
2d. The extreme force and the arrangement of some of them, viz. 

a. The thickness of the peronei muscles in the leg, the lower head 
of which always draws the leg backward and extends it, while the 
upper two prevent the body from falling forward. 

b. The arrangement of the flexors of the leg compared with that of 
the flexors of the fore-arm ; for one of the three long flexors of the first 
of these limbs is manifestly developed only in part ; so that the number 
of the corresponding muscles in the fore-arm is much greater than in 
the leg. 

c. The thickness of the glutei muscles, particularly the gluteus 
maxim us. 

d. The multiplication of the muscles of the fore-arm to execute the 
peculiar motions of the bones of the fore-arm : so likewise the differ- 
ence between the number and development of the special muscles of 
the thumb and little finger and those of the large and small toes. 

e. The deeper situation of several of the muscles of the fore-arm in 
the upper extremity, and the foot only in the lower : such are particu- 
larly the flexor brevis and the extensor communis brevis. 

/. The slight extent of the insertion of the flexors of the leg, which 
favors the extension of this limb and prevents the continued forced 
flexion it experiences in quadrupeds. 

g. The smallness of the small muscles of the head, which, in con- 
rii ci ion with the looseness of the cervical ligament and the anterior 
position of the occipital foramen, forms a very striking character, espe- 
cially when we regard the great development of these parts in quadru- 
peds, the head of which is however smaller than that of man. 

§ 1287. All these circumstances united prove sufficiently that the 
erect posture on the lower limbs is natural to man. 

We must next examine how the erect posture is preserved in a 
state of repose, and how the body when erect exercises the motion of 
progression, or of standing and of ivalking, treating of the modifications 
of each. 



MYOLOGY. 179 



B. OP STANDING. 

§ 1288. The trunk and the lower limbs act in standing. The ]>art 
taken by the trunk consists, 

1st. In the support of the head by the vertebral column. 

2d. In the action of the very strong long muscles of the back which 
fill the channels between the vertebra; and the ribs. They prevent 
the body from falling forward, to which it is in some measure disposed 
from the portion of the pectoral and abdominal viscera before the verte- 
bral column. In fact, they are much more developed in their lower 
part than at their summit. In this part also we feel fatigue and pain 
most sensibly after standing a long time and especially after leaning 
forward. 

The trunk is supported by the lower extremities. Whenever the 
position changes the pelvis presents a broad point of support for its 
weight, and that of the head which is sustained by the vertebral 
column. The articulation of the ossa femoris with the iliac bones in 
front of their union with the spine increases the extent of this base of 
support. 

In standing, the weight of the body passes from this base to the 
thigh, next to the leg, and finally to the foot, so that the body rests 
upon the latter. 

In the usual position on the two feet, besides the peculiarities relative 
to the lower extremities and which we have mentioned above, their 
separation caused by the breadth of the pelvis and the length of the 
neck of the thigh bones is very advantageous, as it increases the 
extent of the base of support which falls between the soles of the feet ; 
thus the attitude becomes unsteady and less firm when the breadth is 
diminished by approximating the feet. 

Standing, inasmuch as it depends on the lower limbs, results from 
the action of all the muscles which arise from the trunk, and from the 
different sections of these members. These muscles contract from 
above downward, and thus move the divisions immediately above 
them, and act in a direction the inverse of that which results in pro- 
gression, since they approximate the least movable point to that which 
is most movable. Thus the most active are, 1st, the glutasi, which draw 
the trunk backward ; 2d, the three flexors of the leg, which prevent the 
pelvis from inclining forward ; 3d, the extensors of the thigh, except- 
ing the rectus, which prevent the limb from falling backward ; 4th, the 
lower head of the triceps sur«, which keeps the leg on the foot in a 
direction intermediate between flexion and extension. 

The other muscles, which confine the action of those we have men- 
tioned, have little or no action, and this action is counteracted by that 
of the others. 

Standing on one foot, where the whole weight of the body rests on one 
of the lower extremities, is practicable, especially by the length of the 



180 DESCRIPTIVE ANATOMY. 

neck of the femur and the breadth of the sole of the foot. This posture of 
the body is preserved by the action of the muscles on the outside of 
the lower limbs, by the broad abdominal muscles, and by the quad] 
lumborum, which act from below upward, preventing the body horn 
falling to the opposite side, where it is unsupported. ... 

In standing on the toes there is no change except in the relations of 
the bones of °the leg and the action of its muscles. The toes an 
tended as much as possible on the metatarsal bones and the foot on 
the le;r, and the weight of the body then rests wholly on the toes and 
also on the sesamoid bones of the foot, which are numerous and 
laree. This position is caused principally by the simultaneous ac- 
tion of the muscles situated on the anterior and posterior faces of the 
leg and foot ; the tibialis anticus, the peronei, especially the peroneus 
brevis, the extensors of the toes anteriorly, and the triceps sura 
posteriorly, are the principal agents. 

At the same time the toes are forcibly pressed against the ground 
by the action of their flexors, hence they are more firmly fixed and 
afford a more solid point of attachment to their muscles. 

C. OF WALKING. 

§ 1289. Walking is produced by the displacement of the lower 
extremities, which move alternately either forward, backward, or 
laterally, so that a distance exists between them, and consequently 
the rest of the body is supported by only one of them. Each motion, 
by which a limb is raised from the ground, separated from the other, 
and is replaced on the ground, is a step. 

This motion, in whatever direction it is performed, depends princi- 
pally on the displacement of the femoral articulation, which is flexed 
in w r alking forward or sideways, and, on the contrary, extended in 
walking backward. 

When we walk forward or backward the knee-joint is generally 
slightly bent, which serves to raise the foot still more. The metatarso- 
phalangean joint is most generally forcibly extended, articular when 
the lower limb which is to be moved is behind the other. In walking, 
the flexion of the haunch carries one of the two limbs more or less 
before the other ; when left to itself, and the coxo-femoral articulation 
is not bent, the foot falls again to the ground and the step is finished. 
If we take long steps the pelvis also turns more or less around the 
limb which remains fixed as around an axis ; hence the limb which 
moves, and the corresponding side of the body, are carried farther for- 
ward. This effect is caused partly by the flexion of the other sections 
of this limb and partly by the extension of the metatarso-phalangean 
articulation. 

It is merely necessary to mention these motions to know the muscles 
which perform them. 



MYOLOGY. 181 

Running is a quick walk, most generally withlarge steps, which 
differs from the ordinary walk not only by its rapidity, but also because 
all the lower face of the foot rests on the ground. 

Jumping is a sudden movement by which the body rises into the 
air. In order to perform it all the joints of the lower limbs are flexed 
and then suddenly extended ; from the shock which the body expe- 
riences from the soil against which it strikes it is carried upward 
until its weight exceeds the motion communicated to it, and causes it 
to return to the earth. 

The leap in a straight line is always shorter than the oblique leap 
because the weight of the body presents more resistance in the first 
case than in the second. 

In kneeling the articulation of the foot is flexed by the anterior 
muscles of the leg, which act from above downward, and the articula- 
tion of the knee is changed in the same manner by the action of the 
upper heads of the triceps surae muscle. 

In stooping the gastrocnemii muscles of the leg exercise all their 
power ; at the same time the coxo-femoral articulation is flexed more 
or less forcibly in order to lean the body forward, and to prevent its 
centre of gravity from falling behind its base of support, and in this 
manner to prevent its fall. 

§ 1290. The motions of the trunkal) are very limited. This is 
proved by the vertebrae and also by the pieces of the sternum, which 
are firmly united. Thus the motions of the trunk in every direction 
depend but slightly on the displacement of the bones which form it, but 
almost entirely on the lower limbs, and those in the coxo-femoral articula- 
tion, are performed by the muscles which extend from the thigh and leg 
to the vertebral column and to the iliac bones. The mobility of the 
ribs is much greater ; the changes in their situation produce the con- 
tinual alternate changes which take place in the capacity of the chest, 
and which result in inspiration and expiration. The examination of 
these changes and of those which occur in the capacity of the abdo- 
minal cavity will be more in place after describing the pectoral and 
abdominal viscera than here. 

§ 1291. The head moves on the vertebral column ; it bends forward, 
is extended backward, inclines to the side, and turns on its axis. 

The last two motions take place almost entirely between the second 
and first vertebra?, the last of which only accompanies the head. The 
other two occur between the head and the atlas, and not between the 
atlas and axis, because the odontoid process and the transverse portion 
of the crucial ligament almost entirely prevent every displacement in 
this direction between the first and second vertebras. 

Luxation cannot take place in flexion and extension on account of 
the firmness of the attachments ; but it easily supervenes in the rota- 

(1) Winslow, Sur les mouvemens dc la tele, du cou et du rcstc de Vepine du dos, in the 
Mem. de Pans, 1730, p. 492-508. 



182 DESCRIPTIVE ANATOMY. 

tion of the first vertebra and of the head on the axis, when this motion 
is performed quickly. 

The cervical portion of the vertebral column must always be fixed 
in order that these different/motions may be executed. 

§ 1292. The k uppcr limbs are much more movable than the lower 
both in regard to the trunk and their different sections, which doul it less. 
depends on the arrangement of these bones and the ligaments. The 
motion of rotation on the axis particularly is much easier in tbe first, 
than in the second. The greater mobility of the upper limbs, consi- 
dered as a whole, is also increased by the difference remarked in the 
mode of articulation, of the first section of the bones of the two extre- 
mities, for the iliac bones are almost motionless on each other and on 
the vertebral column, while the clavicle and scapula on the contrary 
are very movable both on each other and on the trunk. 

Hence the motions of the upper limbs are not performed solely in 
the scapulo- humeral joint as those of the lower extremities are in the 
coxo-femoral articulation, but take place at the same time in the sca- 
pulo- and sterno-clavicular articulations ; hence they are not only more 
free, but also keep the bones together in the different motions they 
perform. Hence the bones are much less firm, but they require less 
strength, since the upper extremities are rarely obliged to sustain such 
heavy loads as happens for instance in creeping, walking, or standing 
on the hands. 

If we except the fingers and toes, mobility diminishes from the peri- 
phery of the limbs to their centres. 

A great difference between the partial motions of the two limbs 
consists in the power of turning the radius on its axis and around the 
ulna, while the leg cannot move around the thigh, except as a whole, 
the fibula being immovable on the tibia. The leg is capable only of 
flexion and extension, while the fore-arm can execute also the motions 
of pronation and of supination.(l) 

Although in the two latter motions the radius is the principal part 
displaced, the ulna is not however motionless ; for it is slightly ex- 
tended in pronation and a little flexed in supination. 

(1) Winslow, Obs. anat. sur la rotation, la pronation, la supination et d'anlres 
mouvemens en rond, in the Mem. dc Paris, 1727, p. 25-33.— Vicq d'Azyr, QJuvrcx, 
vol. v. p. 343-351. 



ANGEIOLOGY. 1S3 



BOOK IV. 



ANGEIOLOGY. 

§ 1293. The vascular system(l) is composed of a central part, the 
heart, whence all the blood departs and where all this fluid returns ; 
of vessels which carry it away, the arteries ; and of vessels which 

(1) We have already mentioned (vol, i. p. 280) the most important works on the 
general conditions of the structure and external form of the vascular system in the 
normal and abnormal state. We shall now mention the principal descriptive treatises. 
They are, 

I. For the whole system. — J. C. A. Mayer, Anaiomische Beschreibung der 
Blutgifasse des menschlichen Kbrpers, Berlin, 1777, 1778.— F. A. Walter, Angiologis- 
ches Handbuch, Berlin, 1789. 

II. For the heart. — 1st. Complete description of this organ in all its parts, both 
in the normal and the abnormal state ; Scnac, Traite de la structure du caur, de son 
action et dc ses maladies, Paris, 1747, 1778. — 2d. Complete description of it in the 
normal state; R. Lower, Tractatus de corde, item de molu colore et transfusione 
sanguinis, London, 1669. — J.N. Pechlin, Defabricaetusu cordis, Kiel, 1676. — Wins- 
low, Sur les fibres du caur et sur ses valvules, avec to maniere de le preparer pour le 
demontrer, in the Memoires de Paris, 1711, p. 196, 201. — Vieussens, Traite de la 
structure et des causes du mouvement natural ducaur, Toulouse, 1711. — Santorini, 
Obs. anat., Venice, 1724, ch. viii., Deiis qua in thoracemsunt. — Lieutaud, Obs. anat. 
sur le caur, in the Mem. de Paris, 1752, 1754. — 3d. Development of the heart; 
Meckel, Sur Phistoire du developpment du caur et des poumons dans les mammiferes, 
in the Journal complem. du Diet, des sc. midic., vol. i. p. 259. — Rolando, Sur la for- 
mation du caur et des vaisseaux arteriels, veineux et capillaires, same journal, vol. xv. 
p. 323, vol. 16. p. 34. — Prevost et Dumas, Developpment du caur et formation du sang, 
in the Annates des sciences naturelles, vol. iii. p. 46. — 4th. Structure of the heart in 
respect to the arrangement of its fibres ; C. F. Wolff, Dissertationes de ordine fibra- 
rum muscularium cordis, in the Act. Acad. Petropol., 1780-1781, in the Xova act., vol. 
i.-viii. — J. F. Vaust, Rccherches sur la structure et les mouvemens du caur, Liege, 
1821. — S. N. Gerdy, Memoire sur I' organisation du caur, in the Journ. compl. du 
Diet, des sc. med., vol. x. p. 97. — 5th. Pathological state ; A Burns, Observations on 
some of the most frequent and important diseases of the heart, London, 1809. — Pelle- 
tan, M C moires sur quclques maladies et vices de conformation du caur , in the Clinique 
chirurgicale, Paris, 1810, vol. iii. — Testa, Delle malattie del cuore, loro cagioni, specie, 
cura, Bologna, 1810, 1813. — Corvisart, Essaisur les maladies etles lesions organiques 
du caur et des gros vaisseaux, Paris, 1818. — Kreysig, Ueber die Herzkrankheiten, 
Berlin, 1814, 1817. — Laennec, De V auscultation mediate, or Traite du diagnostic des 
maladies des poumons et du caur, Paris, 1819, p. 195-445. — Bertin, Traite des 
maladies du caur et des gros vaisseux, Paris, 1824. 

III. For the arteries. — Haller, Icones anatomica, Gottingen, 1745, 1756. — A. 
Murray, Descriptio arteriarum corp. humani tabulis redacta, Upsal, 1783, 1798. — J. 
F. S. Posewitz, Physiologie der Pulsadern des menschlichen Kbrpers, Leipsic, 1795. 
— J. Barclay, A description of the arteries of the human body, Edinburgh, 1818, 8vo. 
— Tiedmann, Tabxda arteriarum corporis humani, Carlsruhe, 1822, 1824.— Hodgson, 
Diseases of the arteries and veins. 

IV. For the veins. — Besides the tables of Loder see Breschet, Sur le systeme 
veineux, now publishing. 

V. For the Lymphatics. — The works mentioned in the first volume contain also 
a description of this system. 



184 DESCRIPTIVE ANATOMY. 

return it, the veins and the lymphatics. The last mentioned carry a 
fluid different from the blood, they are the annexes or appendages of 
the venous system. 



SECTION I. 

OF THE HEART. 
CHAPTER I. 

GENERAL REMARKS. 

§ 1294. The heart (cor) is a hollow muscle irregularly conical or 
pyramidal, situated in the centre of the chest, between the two lungs, 
and inclosed in a special envelop called the pericardium. Its vessels 
are numerous, but it has few nerves ; it is formed of several cavities, 
some of which are separated, while others communicate together. Its 
tissue is formed of fibres united in superimposed layers, and is connected 
on one side with the large venous trunks of the lungs and body, and 
on the other with the large arterial trunks of both. Each of these 
characters deserves to be specially considered. 

I. FORM. 

§ 1295. The shape of the heart is that of a cone or an irregular 
pyramid. We distinguish in it a broad and thick base (basis) and a 
summit (apex), which is generally blunt and bifurcated, an upper and 
anterior face which is concave, and an inferior and posterior which is 
smaller and flatter ; two edges, a posterior which is thick and pointed, 
the anterior is smaller, shorter, thin, and sharp. 

The base of the heart is formed, properly speaking, by that part of 
the organ directly connected with the veins : we may then term it the 
venous portion of the heart (pars cordis venosa). However we gene- 
rally apply the term base of the heart to the upper region of the arterial 
portion. The venous portion is formed of two auricles. It is separated 
from the next by a large groove, called the groove of the base, the awri- 
cuto-ventricular groove, or circular groove (sulcus baseos, s. atrio-veniri- 
cularis, s. circularise). Its form is an oblong square and its breadth 
exceeds its height. 

The succeding portion, which is situated before the auriculo-ventri- 
cular groove, is directly connected with the large arterial trunks. Wc 
may then term it the arterial portion of the heart (pars arteriosa cordis). 
It is formed by the two ventricles. It terminates in a blunt summit, 
which is usually more or less evidently grooved. This groove is some- 
times very large. 



ANGEIOLOGY, 185 

The longitudinal groove (sulcus cordis longitudinalis superior el infe- 
rior) exists on both faces of the heart, from its base to its summit, and 
consequently in all its length. 

The principal branches of the nutricious vessels of the organ are 
situated in these grooves : they communicate on the side of the base by 
a groove, which descends perpendicularly between the two auricles, 
and on the summit by the depression observed in this place. They 
mark the course of the septum within the heart (septum cordis). 

§ 1396. The septum passes also across the venous portion of the 
heart or the auricles as well as its arterial portion or the ventricles. It 
separates completely these two synonymous parts, and consequently 
divides the heart into a right or an anterior and a posterior or left half. 
That part which passes between the auricles is called the septum atri- 
one»i, and that between the ventricles is called the septum ventriculorum. 
The right part of the heart is called the pulmonary heart (cor pulmonale), 
because the pulmonary artery arises from it, or the heart of the black 
blood, from the color of this fluid within it. The left is termed the 
aortal heart (cor aorticum), because the aorta arises from it, or the heart 
of red blood, from the color of the blood within it. We employ sometimes 
also the terms of first ventricle, to designate the anterior, and second 
ventricle, to mark the posterior ; but these are less convenient. 

II. WEIGHT AND SIZE. 

§ 1297. The weight of the heart in a fully grown man is about ten 
ounces ; whence it is to that of the whole body as 1 is to 200. 

Its length, measured from the centre of the auricles, is between five 
and six inches ; its mean length is five and a half inches, four of which 
are for the ventricles and one and a half for the auricles. The breadth 
of the ventricles united is generally three inches at their base and that 
of the auricles is three and a half inches.(l) 

III. SITUATION. 

§ 1298. The heart is placed obliquely from right to left, from behind 
forward, and from above downward ; so that its base is nearly opposite 

_ (1) A knowledge of the perfectly normal proportions of the heart in the healthy state 
is very important to the physician, since without it he can establish no certain diag- 
nosis of the diseases of the central organ of the circulation. We cannot do better 
than to quote the following passage of Laennec on this subject : " The heart in- 
cluding the auricles, should be equal to, a little less, or a little larger than the 'first 
of the subject. The walls of the left ventricle should be a little more than twice as 
thick as the walls of the right ventricle ; they should not collapse on cutting into the 
ventricle. The right ventricle, a little larger than the left, presenting smaller fleshy 
pillars, although its panetes arc thinner, ought to collapse after the incision " (De 
I auscultation mediate, vol. n. p. 270.) "Reason teaches and observation prove* that 
in a well formed subject the cavities of the heart are nearly equal ; butas the parietes of 
the auricles are very thin and those of the ventricles are much thicker, it follows that 
the auricles form only one third of the whole volume of the orgsln or the half of that 
of the ventricles." (lb.) p i> 

Vol. II. 24 



186 DESCRIPTIVE ANATOMY. 

the eighth dorsal vertebra, from which it is separated "by the esopha- 
gus and aorta, and its summit corresponds to the cartilage of the sixth 
rib, or to the interval, which separates it from the next. Its lower face, 
which is flattened, corresponds to the upper face of the central tendon 
of the diaphragm, and the upper to the central and left portion of the 
anterior wall of the chest. 

IV. TEXTURE. 

§ 1299. The heart is formed of several layers of muscular fibres, 
situated between two thin, smooth, and polished membranes, the inner 
and outer membranes of the heart. The latter is the inner layer of the 
pericardium. 

The outer surface of the heart is smooth and uniform in relation to 
the inner, even when we have removed the outer membrane. 

The inner surface is very uneven and reticulated, which arises from 
its- being formed of numerous rounded, flat, and distinct muscles, which 
intercross continually and which are called fleshy pillars (trabectda 
carnece). The mnscular substance of the heart is generally harder, 
more solid, and more elastic than that of other muscles. 

As the arrangement of these fibres(l) differs wholly in the venous 
portion from what it is in the arterial portion, as it is not exactly the 
same in the right and left portions, and as it finally differs according 
to the subject, all that can be said generally may be reduced to the 
following corollaries :(2) 

1st. The directions of the layers are more or less opposite. But in 
the recent state, far from being entirely separated from each other, they 
intercross differently ; so that all those of one portion of the heart con- 
stantly contract uniformly and diminish the cavity they circumscribe in 
every direction. 

The union of the different layers takes place partly by more or less 
manifest muscular fibres. 

2d. The fibres which form the layers are united in fasciculi of va- 
rious sizes, which vary more or less in their origin and their direction, 
and which are often separated by greater or less spaces. These fas- 
ciculi are sometimes rounded and sometimes flattened, — a difference 
which seems to depend on determinate laws, since it is constant in the 
different regions of the heart. For instance the right and left ventricles 

(1) Wolff, De or dine fibr arum muscularium cordis, diss. vii. De stratis fibrarum 
in universum. In nov. act. petrop., vol. iii., 1785, p. 227-249.— Gerdy, loc. cit., p. 101.- 
Vaust, loc.cit., p. 102, etc. 

• * 2) Ge J ty has establi3hed alaw . th at all the fibres, whatever is their extent, situa- 
tion, and direction, form webs, which are convex toward the point of the heart, and 
which are nearly superficial at one extremity and deep at the other ; so that for 
instance the external or internal fibres are the same reversed, and having passed 
through the thickness of the ventricle. The extremities of these muscular webs are 
constantly inserted in the base of the heart, around the different auricular and arte- 
rial orifices of the ventricles, either directly or by tendons attached to the auriculo- 
ventricular valves (loc. cit., p, 101). p T 



ANGEIOLOGY. 187 

are not similar in this respect nor in regard to the arrangement of their 
fibres, and the same is true of other parts also. Thus the inner layers 
are generally rounded and form fleshy pillars. The auricular appen- 
dages of the auricles are formed of rounded fasciculi, and the auricles of 
flattened fasciculi. 

From this arrangement we may deduce that the firmest parts are 
formed of rounded fasciculi. But the fibres and the fasciculi formed by 
them are united by intermediate fibres, which may be distinguished 
with facility. 

The fibres and fasciculi are every where interlaced with each other, 
conformably with all the involuntary muscles. They are united principal- 
ly in two ways : sometimes the ends of the fibres and fasciculi join, and 
sometimes they are united by intermediate filaments, which arise from 
their lateral portions. 

In the first case, either the fasciculi go to meet each other and the 
extremities of those which continue together intermix like the teeth of 
a saw, as is the case with the digitations of several adjacent muscles, 
or some fibres are attached obliquely to others at acute angles, as the 
fibres of the penniform muscles are implanted in their tendons, and 
finally, as is the case most generally, the fibres or fasciculi which go 
side by side unite at very acute angles. 

The lateral union takes place principally between the insulated fibres 
and the small fasciculi of fibres, especially in the outer layer. Some- 
times it is irregular ; so that those fibres which are evidently separated 
in the rest of their course are placed one against another in a part of 
this same course, whence the reticulated structure is more or less evi- 
dent. It is sometimes regular, and we see oblique fibres going from 
each side, which unite. The redness and determinate form of the inter- 
mediate filaments always demonstrate that they are not formed of cel- 
lular tissue but of real muscular substance. 

The mode in which the filaments are united also presents determi- 
nate differences in the different regions of the heart. 

3d. In the ventricles, the external layers go obliquely downward, 
backward, and from right to left. The direction of the central is oppo- 
site, and the most internal, which form the fleshy pillars, extend longi- 
tudinally from the summit to the base. 

On the contrary, the transverse direction predominates in the auricles. 
The external layer, which is the strongest, proceeds in this direction, 
while the internal, which forms only insulated fasciculi, has a longi- 
tudinal direction. 

4th. All the external layers are not equally extended. Generally 
the external layers are those only which cover all the surface of the 
ventricles ; the central are smaller and occupy only a third of the 
heart. If we except the most internal, that which forms the fleshy 
pillars, they diminish in direct ratio to their depth. They disappear 
first at the summit of the organ, and in reascending from this point to 
the base of the ventricles, they are deeper and deeper ; so that the deepest 



188 DESCRIPTIVE ANATOMY. 

are found only at the base. Hence this part of the heart is the 
thickest. 

We observe also occasional spaces between the layers, which ex- 
tend the whole length or all the breadth of the ventricles. 

5th. The outer layers differ from the central ones, inasmuch as they 
are stronger and their fibres are more intimately united together. 

Thus the fibres and the fasciculi of the inner layers are more easily- 
demonstrated. But the external forcibly embrace and compress these 
latter ; so that they contribute essentially to the firmness of the 
heart. 

6th. The fibres of the two portions of the heart are not continuous, at 
least not all of them, with each other, so that the same layers are 
reflected on the two ; but the fibres of the two ventricles terminate in 
the septum. The upper and lower faces of the heart are not arranged in 
precisely the same manner : the separation is seen with more difficulty 
in the first than in the second. We remark also three different arrange- 
ments in the upper face. In fact, either we cannot distinguish the 
least trace of separation and the fibres are uninteruptedly continuous 
with each other, or two fibres are in fact applied one on the other, but 
a species of suture serves as a line of demarkation between them, or 
finally they mingle with each other by digitations. 

Wolff states that on the lower face, the fibres of the two ventricles 
are separated by a distinct and very broad band, formed of longitudinal 
fibres, and which diminishes insensibly from the base to the summit, to 
which these fibres are attached on the two sides. But we have usually 
found but a slight, and often no trace of this arrangement. 

7th. The upper extremities of the fibres of the heart are attached to 
a fibro-cartilaginous tissue,(l) formed 

a. Of two oblong, rounded projections or tubercles, usually three or 
four lines long, little less than a line thick, seen on both sides of the ori- 
fice of the aorta. 

b. Of a thin band, which surrounds the posterior part of the circum- 
ference of the aorta and unites the two tubercles. 

c. Of four filaments, placed in the circular groove on the base of the 
heart, two on the right and two on the left, an anterior and posterior 
on each side. Below these four filaments the two anterior arise from 
the tubercles. The right anterior goes into the anterior and upper part 
of the circular groove ; the left into the upper and posterior part. The 
posterior two arise by a very short common trunk, which is only a few 
lines long, from the band which unites the two tubercles, near that 
of the right side, and proceed in an opposite direction to the lower part 
of the circumference of the circular groove. 

These anterior and posterior filaments are situated at the venous 
orifices of the ventricles. They do not surround the base of the heart 

(1) C. D. F. Wolff, De ordine fibrarum muscularium cordis, Diss, ii., dc textu cartir 
lagine ocordis, sire defilis cartilagineo-osscis eorumque in basi cordis distribulionc. In 
Act. Petropol., 1781, vol. i. p. 211. — Gerdy, loc. cit., du tissu albugine cardiaquc, p. 97. 



ANGEIOLOGY. 189 

and form a complete ring, but terminate near the edges of each orifice 
and gradually lose themselves in the cellular tissue. 

This cartilaginous tissue is surrounded entirely by a thin, firm, but 
loose sheath, a real perichondrium. It is covered more externally by 
the outer membrane of the heart and internally by its inner membrane. 

The external muscular or superficial fibres arise principally from the 
cartilaginous tubercles and filaments, and from the cellular tissue be- 
tween the extremities of the latter ; so that the fibres, which come from 
the tubercles and from the origin of the filaments, adhere to them very 
intimately, while the others are united only by a cellular sheath which 
surrounds them. 

v. vessels. (1) 

§ 1300. The blood-vessels of the heart are proportionally very large 
and are called the coronary vessels (vasa coronaria cordis). The coro- 
nary arteries and veins resemble each other in many respects : 

1st. These vessels (the arteries) arise directly from the beginning 
of the trunks of the vessels of the body, or they (the veins) open directly 
into the heart. 

2d. They turn around the base of the heart in the circular groove, 
whence they send toward the summit large branches which arise at 
almost right angles : these go to the ventricles and proceed along the 
heart, while the others are smaller and follow an opposite direction, 
proceeding to the auricles. 

3d. The large trunks and the large branches extend on the outer 
face of the organ and ramify internally. 

4th. The veins have valves at the places where they open but not 
in their course. There are two arteries of nearly equal calibers, while 
we find only a single large coronary vein, which is constant ; but be- 
side this last we observe several, which are smaller, which open directly 
into the heart, but not constantly, except into the right part of the 
organ, and particularly into the right auricle : they do not open, even, 
except into the septum, and they do not empty their blood into the left 
part of the heart, (2) as some anatomists have pretended, and among 
others Vieussens(3) and Thebesius.(4) In fact, Abernethy has very 
recently supported this latter opinion, viz. that the venous blood of the 
heart mixes with the arterial blood which nourishes the body, without 
passing through the lungs ; he has only modified it by saying, that 
these orifices of the coronary veins in the left portion of the organ serve 
principally to prevent repletion of the right portion in those cases where 
the passage of the blood through the lungs is obstructed ; because, 

(1) Haller, De vasis cordis propriis, Gottingen, 1737.— Iterates observationes, 1739. 
— Geisler, Commentatio de sanguinis per vasa coronaria cordi motu, Leipsic, 1743. 

(2) Sabaticr, Sur lesveines dc Thebesius ; in the Traitcd'anat., vol. iii. 

(3) Nouvelles decouvertes sur Ic caur, Montpelier, 1706. — Traite du occur, 1715. 

(4) De circulo sanguinis in corde, Leipsic, 1708. — De circulo sanguinis per cor, 
Leipsic, 1759. 



190 DESCRIPTIVE ANATOMY. 

having injected the cardiac arteries and veins in a subject whose lungs 
were diseased, he has seen the fluid penetrate into the left ventricle by 
broad openings. But as generally injections, even when very fine, 
transude on all the inner face, although no venous orifices are pen ep- 
tible on the left side, we have reason to admit that the openings exist- 
ing in the cases observed by Abernethy were produced accidentally, 
either during life or after death, by obstacles to the course of the injec- 
tion, on account of the feeble resistance of the tunics of the veins weak- 
ened by disease, and considerably distended, both by the blood accu- 
mulated in these vessels and by the injected mass. 

VI. NERVES. 

§ 1301. The nerves(l) of the heart are proportionally smaller than 
those of the voluntary muscles. They arise from the upper and lower 
cervical ganglions of the great sympathetic nerve, from the cervical 
portion of the nerve between these two ganglions, or from the centra] 
ganglion sometimes found in this place. Some arise directly from the 
nerve, others from the plexuses formed by the filaments which come 
from the ganglions and by others sent off by the pneumo- gastric nerve. 

The relations of the nerves of the heart with its muscular substance 
have been the subjects of dispute. Some anatomists, Behrcnds(2) 
among others, deny that this substance, and consequently that the heart, 
possesses nerves, which they pretend are distributed only to the cardiac 
vessels. Others on the contrary, as Scarpa, Munniks,(3) and Zeiren- 
ner,(4) maintain that they really go to the heart as well as to all other 
muscles. 

The partisans of the first hypothesis adduce the following arguments : 

1st. Anatomical examination, whence it results that the cardiac 
nerves, which we cannot follow except to the third ramification of the 
coronary arteries, do not enter the substance of the heart but go only 
to the arteries. (5) 

2d. The origin of the cardiac nerves ; they arise from the great 
sympathetic nerve, the ramifications of which go only to the arteries. (6) 

(1) J. E. Neubauer, Descriptio nervorum, cardiacorvm, Frankfort and Leipsic, 
1772. He has figured the nerves of the right side. — E. P. Andersch, Denervis; in the 
Nov. comm. Gatt., vol. ii., and Konigsberg, 1797. He has represented those of the left 
side. These figures have been copied in Haase, Cerebri nerrorumque corj)oris kumani 
repetita, Leipsic, 1781. — A. Scarpa, Tabula ncurologicce ad illustrandum hvstoriam 
anatomicam cardiacorum nervorum cerebri, glossopharyngwi ct pharyngcei ex octavo 
cerebri, Pavia, 1794. 

(2) J. Behrends, Diss, qua demonstralur cor nervis carere, addita disquisitionc de 
vi nervorum arterias cingentium, Mayence, 1792. — A. T. N. Zcrrenner, An cor nervis 
careat Usque carere possit ? Erford, 1794. 

(3) Obscrvaliones varies. Diss. auat. med., Groningue, 1R05, 1-17. 

(4) Zerrenner, An cor nervis careat Usque carere possit ? Erford, 1794. 

(5) Behrends, loc. cit, p. 5, 8. 

(6) Id., ibid., p. 8. 






ANGEIOLOGY. 191 

3d. The smallness of those nerves which is in direct ratio with the 
thinness of the fibrous coat of the arteries,(l) and which contrasts on 
the contrary with this law, that the number and size of the nerves 
correspond to the power and frequency of the motions of the mus- 
cles.(2) 

4th. The insensibility of the heart, the motions of which are inde- 
pendent of the nervous system, since it beats regularly although 
removed from the body,(3) and the excitement of the nerves, whether 
mechanically or dynamically, by means of galvanic electricity, do not 
alter its motions,(4) and its pulsations are not deranged when the ner- 
vous system is paralyzed as in apoplexy. (5) 

5th. The integrity of the motions of the heart, notwithstanding the 
administration of opium. (6) 

But all these arguments can be refuted with greater or less facili'y. 
In fact : 

1st. The manner in which the cardiac nerves are distributed and 
their proportion both to the muscular substance and to the vessels, 
do not differ essentially from what is seen in the same respects in 
the voluntary muscles. (7) Here also the nerves and the ramifications 
of the vessels are very compactly situated in regard to each other, and 
we do not see the nerves unite to the muscular subhance. Besides 
the cardiac nerves are closely connected with the vessels only in their 
largest branches, and not at all in many animals. 

2d. The muscular substance of the heart is only a greater develop- 
ment of the fibrous membrane of the vascular system, so that the dis- 
tribution of the branches of the great sympathetic nerve within it does 
not present an aberration from the type of this nerve. 

3d. The cardiac nerves possess more medullary substance than 
those of the voluntary muscles. They arise from the ganglions of the 
great sympathetic nerve, and through them from all the spinal 
marrow.^ Their action is probably favored by the mutual contact of 
the blood and of the inner face of the heart ; very probably also the 
size of the nerves which go to the voluntary muscles relates to their 
functions which is to conduct the influence of the will. 

4th. The facts cited in the fourth paragraph are explained partly by 
the smallness and partly by the texture especially the softness and 
gelatinous nature of the cardiac nerves, and from the circumstance 
that they arise from the ganglions. Besides they are correct only to 
a certain extent, since the motions of the heart are not entirely inde- 
pendent of the nervous system. The passions have a marked influ- 
ence on the number and strength of its pulsations. Impressions of 

(1) Beh rends, loc. cit., p. 8, 9. 

(2) Id., ibid., p. 10. 

(3) Id., ibid., p. 11. 

(4) Id., ibid., p. 20. 

(5) Id., ibid., p. 12. 

(6) Id., ibid., p. 11. 

(7) Scarpa, loc. cit., § 13. — Munniks, loc. cit., p. 6. 



192 DESCRIPTIVE ANATOMY. 

every kind on the nervous system modify its motions more or less sen- 
sibly.(l) 

In fact several observers, particularly Valli, Volta, Klein,(2) and 
Bichat, have doubted the influence of electricity on the motions of the 
heart; but the observations of Fowler, Schmuck, Pfaff,(3) Rossi, (4) 
Giulio,(5) Humboldt,(6) Munniks,(7) and Nysten, and our own also, 
prove it to be real. 

The non-affection of the heart in paralysis of the brain proves nothing 
in regard to the relations between the nerves and this organ, since the 
irritability of the voluntary muscles is not altered in apoplexy. This 
apparent difference depends only on that between the excitants of 
the voluntary and involuntary muscles. In fact the excitant of the 
first is the influence of the brain, and that of the second the substance 
contained in their cavity, which in the present case is the blood. The 
motions of the heart continue also in cerebral paralysis, while those 
of the other muscles are not performed ; the activity of these last seems 
extinct while it is only no longer seen. 

5th. The observations of Haller, of Fontana, of Whytt,(8) and of 
Alexander,(9) prove that the heart, like the voluntary muscles, is sen- 
sible to the influence of opium, whether the narcotic acts directly upon it, 
or is placed id contact with the nervous system or with any organ 
whatever. These observations and experiments prove that the rela- 
tion between the heart and the nerves is perfectly like that between 
the nerves and muscles generally, and more, because the effect of opium 
upon the heart is much more evident when this substance is placed 
in relation with the nervous substance than when applied directly to 
the heart. 

VII. VENOUS PORTION. 

§ 1302. The characters of the venous portion of the heart,(10) the 
auricles, are, 

1st. The muscular substance of its parietes is so thin that the two 
membranes of the heart touch in several places. 

2d. Its form is irregularly quadrilateral. 

(1) See on this subject Legallois, Experiences sur le principe de la vie, Paris, 1812, 
—Wilson Philip, in the Phil. Trans., 1815, part i. p. 65-97 ; part ii. p. 224-246.— Id. 
An experimental inquiry into the laics of the vital J unctions, London, 1818. 

(2) In Pfaff, Leber thierische Elcctricitdt und Reizbarkcit, p. 119. 

(3) In Ptaff, loc. cit., p. 140. 

(4) Mem. de Turin, vol. vi. 

(5) Voight, Magazin, vol. v. p. 161. 

(6) Ueber die gereizte Muskel-und Nervenfaser, vol. i. p. 340-349. 

(7) Loc. cit., p. 1 15. 

(8) In Pfaff, foe. cit., p. 140. 

(9) Memoirs of the Manchester society, vol. i. p. 98. 

(10) Ruysch, Epist. anat. problemata decima de auricutarum cordis earumqvc 
fibrarum motricium struclura ) Amsterdam, 1725. — A. F. Walther, De struclur a cordis 

auricularum, Leipsic. 



ANGEIOLOGT. 193 

3d. It is composed of a part into which the veins open directly the 
cavity of the auricle, the sac (sinus), and another upper and anterior, 
the auricular appendix (auricula), which projects above the sac. 

The exact limits of these two parts cannot be pointed out, or rather 
anatomists do not distinguish them according to the same principles on 
the right and left sides. On the left side the appendix is readily dis- 
tinguished from the sac, because it suddenly forms a very rounded pro- 
jection, which is much narrower, and has thicker walls on the upper 
anterior and left angle. On the right side, on the contrary, this name 
is applied to a part, the walls of which are very thick, which is 
formed on the left by the confluence of the two venae cava?, terminates 
above in a blunt summit, and which is not sensibly separated from 
the rest, while, if we remained true to the analogy, this term should 
be applied only to the small appendix which terminates the auricle 
above, and which is elevated on the left along the vena cava superior. 

4th. It is directly continuous with the venous trunks winch open 
into it. 

VIII. ARTERIAL PORTION. 

§ 1302. The characters of the arterial portion of the heart, the 
ventricles, are, 

1st. Their parietes are thicker, so that the internal and the external 
membranes are every where separated from each other by a muscular 
substance. The thickness of the parietes of each portion of the heart 
is then in direct ratio with the extent passed through by the blood 
it sends forward. 

2d. The arterial portion is considerably larger and broader than the 
venous portion. 

3d. Its external form is elongated, rounded, and pyramidal, and 
determines, properly speaking, the form of the whole heart. 

4th. At its upper extremity are two openings, the venous and the 
arterial, which establish the communication, the first between the ven- 
tricle and the auricle, and the second between the ventricle and the 
artery \v hich arises from it. The venous orifice is almost perpendicular ; 
its direction is from before backward and from right to left ; the arterial 
is almost horizontal and is situated a little above the former farther in- 
ward and nearer the septum. 

Both are rounded ; the venous is broader than the arterial. Its form 
is elliptical, while the latter is nearly circular. 

Neither the venous nor the arterial opening is perfectly loose ; both 
have valves. The valves placed at the arterial opening are very 
similar in their arrangement to those found in the common veins ; they 
are however much larger and are usually three in number. Their 
convex and attached edge looks toward the heart while the loose edge, 
which has two concavities and which is thicker than the rest of the 
membrane, is turned toward the cavity of the artery. In the centre 

Vol. II. 25 



194 DESCRIPTIVE ANATOMY. 

of the latter we observe a fibro-cartilaginous tubercle (nodulus). The 
blood which comes from the ventricle pushes them towanl the circum- 
ference of the artery and against its parietes. On the contrary the 
blood which tends from its specific gravity to return from the arterv 
into the ventricle separates them from these same parietes, their loose 
edges then touch, and they form a horizontal septum between the 
cavity of the artery and the ventricle, which prevents the reflux of 
the blood into the latter. The tubercles complete this septum and 
close the space in the centre of the artery between the three valves. 

The valves of the venous orifice differ from those of the arterial 
opening, and from all other valves, since they are attached much more 
firmly, hence they close more completely the opening around which 
they are placed. A narrow cartilaginous ring, which is not however 
perfect, exists on all the circumference of the venous opening ; this 
sometimes ossifies in advanced age, especially in the left portion of the 
heart, and is situated deeply between the muscular fibres of the ventri- 
cle and those of the auricle. 

This is the cartilaginous tissue already described as the origin of 
the external muscular fibres of the heart. The venous valve is 
attached to this tissue by its posterior edge, but its opposite and uneven 
edge, unlike that of all the other valves, is not loose ; many flat and 
solid tendinous filaments, which extend from the base to the summit of 
the heart, arise from the valve, on which they are often united or pass 
over it and go to the opposite part of the circumference of the heart, 
soon unite into larger cords, and are attached to the parietes of the 
heart, and principally to its fleshy pillars. As the latter shorten when 
the heart contracts, the different parts of the valves then approach 
each other and the opening is forcibly closed. It is necessary that 
the loose edge of these valves should be thus attached since they must 
resist not only the weight of the blood like the other valves, but also 
the action of the muscular parietes of the heart, which forcibly push 
forward the arterial blood. 

5th. The arterial portion of the heart is divided into an upper and 
lower half, which are separated by the upper part of the valve of the 
venous orifice at the upper and posterior parts of the ventricles, and 
which blend together at the summit of the heart, so that the ventricles, 
although resembling externally an elongated cone, form in fact two 
arched canals, convex forward, and the greatest convexity of which 
corresponds to the summit, and are more extensive in this part than in 
any other. 

6th. The reticulated structure of the ventricles is much more dis- 
tinct than that of the auricles. Some of the fleshy pillars form rounded, 
elongated projections, terminating in blunt summits (musculi papillares), 
which go toward the base of the heart, and from the extremity of 
which several tendinous filaments proceed to attach themselves to the 
loose edges of the venous valves. Farther, those fleshy pillars which 
are attached by their two extremities, as well as those which have 



ANGEIOLOGV. 



195 



one end loose, communicate with each other at intervals by tendinous 
fibres. The direction of the principal fasciculi is longitudinal, the 
smaller which unite the preceding are oblique. Near the summit the 
reticulated texture is more and more developed, and the parietes be- 
come thinner in the same proportion. 

IX. RIGHT AND LEFT PORTIONS. 

§ 1303. 1st. The right half of the heart is considerably thinner than the 
left. This difference is very striking between the two ventricles, where 
the relation is generally as one to four or to five. Even then we find, 
as between the auricles and the ventricles generally, that the power 
of the parietes is in direct ratio with the space passed through by the 
blood which comes from them. The greater thickness of the walls of 
the left ventricle determines the form of the whole arterial portion of 
the heart. The right wall formed only by the septum is convex, and 
the left appears fitted to it like a sling. 

2d. The substance of the right side, especially that of the ventricle, 
is softer and looser than that of the left side. 

3d. The right side is broader than the left after death.(l) This 
difference also is most marked between the two ventricles, but it is not 
yet determined if it exists constantly during life or supervenes only 
after death. 

Many anatomists, particularly Lower,(2) Santorini,(3) Weiss, (4) 
Lieutaud,(5) and Sabatier,(6) have adopted the latter opinion, while 
most others favor the first. 

This hypothesis has been supported sometimes by the result of 
measurement, and sometimes by the fact that the left ventricle is as 
much longer as the right is broader, and sometimes by experiments 
and observations, from which it has been concluded that the right 
side appears broader after death, only because it is more distended by 
the blood which remains stagnant in the lungs from their inaction, 
while previously the passage of the blood from the left ventricle was 
not obstructed ; whence the left ventricle seems to be narrower com- 
pared to the right, in proportion to the less quantity of pulmonary 
blood received by it through the pulmonary veins. In men and ani- 
mals who have died suddenly from the injury of the large vessels, 
or of those which communicate with the right portion of the heart, 
when consequently this cause of the distention of the right ven- 

(1) Helvetius, Sur Vincgalite de capacite qui sc trouve entre les organcs destines 
a la circulation du sang, dans le corps de Phomme, et sur les changemens qui arri- 
vent au sang enpassant par le poumon, in the Mem. dc Paris, 1718, p. 222-281. 

(2) Loc. cit., p. 34. 

(3) Loc. cit, p. 144, 145. 

(4) De dextro cordis rentriculo post mortem ampliore, Altdorf, 1745. 

(5) Essais anat., p. 230, 231. 

(6) Sur I'inegale capacite des cavites du eceur et des vassieaux pulmonaircs, in the 
Mem de Paris. 

(7) Lieutaud has brought forward this argument. 



196 



DESCRIPTIVE ANATOMY. 



tricle did not exist, the capacity of the two portions has been exactly 
or nearly the same.(l) Finally, when the left ventricle is placed in 
the same condition by means of a ligature as is the right ventricle at 
the time of death ; while on the contrary the blood is removed from 
the latter by cutting the pulmonary artery, or the vena cava, we find 
that the relation between the two ventricles is the inverse of that 
which commonly exists, that is, that the right ventricle is narrower 
than the left. (2) 

The veins appear much larger than the arteries after death, undoubt- 
edly from the same cause. 

To these experiments we may add that we sometimes find the right 
ventricle narrower than the left from the effect of disease, such as ossi- 
fication or some other malady of the valves of the aorta, in which case 
the difference must be explained precisely in the same manner. We 
have before us several preparations in which, beside a considerable 
dilatation of the left ventricle arising from this cause, there is at the 
same time a great contraction of the right ventricle, proving that the 
results drawn from these facts cannot be opposed, by saying that the 
dilatation of the right cavity of the heart in the usual state of things 
should extend also to the left portion from the influence which it exer- 
cises on the veins and arteries of the body, and consequently that the 
right half is really larger during life since the left is itself distended. 
Since the cause of the greater distention of the right portion, that is, 
the more difficult passage of blood through the lungs, supervenes only 
at the moment of death, the opinion that the right ventricle is also more 
capacious during life cannot be sustained. (3) 

That the cause above mentioned is that which increases the capa- 
city of the right portion of the heart at the period of death only, is 
proved by the fact that the difference between the two portions of the 
organs varies with the cause of death, and that it increases in a direct 
ratio with the increase of the obstacle to the circulation of the blood in 
the lungs. Thus, in those animals killed by drowning, hanging, and 
suffocation, Colman has found the right ventricle generally twice 
the size of the left, although its proportions commonly mentioned are 
much smaller. (4) In fact, Haller asserts that in one subject he found 
it three times as large as the left, (5) but the usual estimates are much 
less than this. Gordon says the relation is sometimes as 5 : 4,(6) Lie- 
berkuhn as 3 : 2,(7) Portal as 7 : 5,(8) Helvetius(9) and Legallois,(10) 

(1) Weiss, loc. cit. — Sabatier, loc. cit. 

(2) Sabatier, loc. cit. 

(3) Haller, Elem. phys., vol. ii. p. 134. 

(4) On suspended respiration from drowning, hanging, and suffocation, London, 

1791. 

(5) Loc. cit., p. 133. 

(6) System of human anat., vol. i. p. 38. 

(7) Bamberger, Physiologie, p. 708. 

(8) Mem. de Paris, 1770, p. 245. 

(9) Loc. cit. 

(10) Diet, des sc. mid. vol. v. p. 440. 



ANGEIOLOGY. 197 

as 6 : 5, Brown Langrish as 11 : 10.(1) Gordon has found the two 
ventricles nearly equal in some cases,(2) and Portal asserts that their 
capacity is the same in young people.(3) 

These differences in the estimates of authors furnish a new argu- 
ment against the common opinion, since we should presume that they 
depend on greater or less accidental obstacles to the pulmonary circula- 
tion. 

We cannot however deny but that the capacity of the right portion 
of the heart is a little greater than that of the left, because the blood 
brought by the vena cava has received the fluid contained in the tho- 
racic canal. It is also proved by the difference relative to the age in 
the degree of disproportion, this being, directly after birth, less than at a 
more advanced period of life. (4) 

Legallois has also found the right portion of the heart a little broader 
than the left in every kind of death, both after strangulation and from 
the loss of blood. (5) The facts related prove only that the right por- 
tion of the heart can contract as much as, and even more than the left, 
in certain circumstances, and that the left, is also susceptible of becoming 
larger than the right, but not that the capacity of the latter exceeds 
that of the former during life. 

4th. The fibres of the right side, especially those of the ventricle, 
are not arranged in the same manner as those of the left side. 

a. The thinness of the right ventricle is attended also with fewer 
fibrous layers, a fact already pointed out by Senac,(6) but which Wolff 
has indicated more precisely in saying that the right ventricle is 
formed of three layers only, while that of the left side presents six, 
counting the fleshy fasciculi of its internal face. (7) We have not 
however been able to find this number of layers. Usually we have 
observed on each side only three distinct layers, two oblique, and one 
internal longitudinal. 

b. The fibres of the right ventricle are flatter and thinner than those 
of the left. Thus the former form flattened fasciculi, and the second 
rounded and thicker fasciculi. The latter ramify more ; they are 
separated by fat, and have spaces between them, while we can hardly 
distinguish the former from each other except by the direction of 
their fibres. 

c. The fibres of the right ventricle are more oblique and annular, 
while those of the left are more longitudinal. 

d. The layers of the right ventricle, although thinner, are much 
more distinct than those of the left ventricle ; besides the latter are still 

(1) De part, corp hum. fabric., vol. ii. p. 133. 

(2) Loc. cit., p. 38. 

(3) Loc. cit. 

(4) Portal, loc. cit. 

(5) Tr. du coeur, vol. i. p. 200. 

(6) De stratis ftbrarum cordis in universum, in the Nov. act. Petrop. vol. iii. an. 
1785, p. 234-238. 

(7) Loc. tit., p. 234. 



198 DESCRIPTIVE ANATOMY. 

more similar in regard to direction, which doubtless contributes to make 
the left ventricle firmer, but proves at the same time that we should 
exercise some judgment in determining the number and direction of 
these layers. Such at least is the positive result of our researches. 
This also is the opinion of Wolff himself, who has studied the arrange- 
ment of the heart with too much exactness. 

5th. The primitive form of the heart, that of a canal curved on 
itself, is more evident in the left ventricle than in the right. 

6th. The nerves of the left side are larger and more numerous than 
those of the right side. 



CHAPTER II. 

SPECIAL REMARKS ON THE HEART. 

§ 1304. We usually describe first the right half of the heart ; and in 
order to follow the direction of the circulation of the blood, we begin 
with the right auricle. 

I. RIGHT AURICLE. 

§ 1305. The right auricle {atrium anterius, s. venarum cavarvm, 
s. dertrum), forms that portion of the base of the heart situated farthest 
on the right and forward. 

Its form is almost square ; the vena cava superior descends obliquely 
from right to left, and from behind forward, towards its upper and 
right angle, and the vena cava inferior ascends in a contrary direction 
towards its lower and right angle. Notwithstanding this difference 
in the direction of the two vena? cavae, we must admit that they unite 
and form a single trunk in the cavity of the auricle, for they unite on 
the right forward and backward, and the absence of the left side of 
their circumference is only apparent, since this side in fact exists, but 
is dilated to produce the muscular part of the auricle. The upper and 
left angle of the latter extends into a small blunt appendage, formed 
like a rounded square, which is observed before the lower pait of the 
aorta. The lower and left angle is rounded. 

We observe transverse fibres on all the circumference of this auricle, 
directly below the inner membrane of the heart, which, becoming 
thinner and separating from each other above and below, are prolonged 
for a small distance around the superior and inferior venae cavac. 
They are thinner where they surround the point of union of the two 
vena? cava? forward, and are extended more uniformly, and are smoother 
on the right side, both on their outer and on their inner face. 

But the left part of the posterior face of the anterior and unattached 
wall of the right auricle, which is the most extensive, is uneven inter- 
nally. This unevenness depends on much larger and transverse fasci- 



ANGEIOLOGV. 199 

culi, which are united by other smaller oblique fasciculi, so as to pre- 
sent a reticulated appearance. These fasciculi, with which the trans- 
verse fibres of the auricle are united, appear between two longitudinal 
smooth bands which proceed only along its internal face. One of 
these two bands, the left, descends a short distance from the anterior 
part of the venous orifice of the left ventricle; the other, the right, 
situated almost in the centre of the anterior wall, a little however to 
the right, descends toward the left side, along the union of the two 
venae cava. These fleshy fasciculi have been called the peciinceal 
muscles (JVf. pecfinati). 

The posterior wall of the right auricle forms the anterior face of the 
interventricular septum. We discover in it several remarkable parts, 
some of which belong to the history of the development of the heart. 

On the right side and toward the centre is the fossa ovalis (fossa 
ovalis, s. valvula foraminis ovalis, s. vestigium foraminis ovalis), an 
oblong and rounded depression, which varies much in size. This fossa 
is very distinct from the posterior wall of the auricle at its upper part, 
a little less so on its sides, especially on the right, and is generally 
blended with it below, particularly on the right side. The more exten- 
sive it is, the less evident are the limits which separate it from the 
other parts of the posterior wall. It however not unfrequently pre- 
sents a similar arrangement even when it is very small. 

Most generally it exactly fills the space between the edges of the 
projection which surrounds it, and it is very tense, but not unfrequently 
it is much larger, and forms a valve, the loose edge of which corres- 
ponds to the left auricle. We almost always observe a greater or less 
depression above, between its extremity and the upper part of the pro- 
jection which surrounds it. Very often also we see in this place one or 
more openings by which the cavity of the two auricles communicate. 
This arrangement is not constant, and it is entirely independent of the 
extent either of the valve or of the depression, although it occurs parti- 
cularly when the valve is very broad. Even when the openings are 
large and numerous, they seldom descend below the central part of the 
projection which surrounds the depression, so that the septum of the 
auricles is complete in regard to the separation of the blood contained 
in the two cavities. 

This place, especially in its upper part, is the thinnest portion of the 
septum and of the auricle generally. We however always observe 
muscular fibres between the two layers of the internal membrane of 
the heart, that of the right and that of the left auricle. 

The projection which surrounds this depression is formed of reticu- 
lated muscular fibres. It is called the ring or the isthmus of Vieus- 
sens (annulus, s. isthmus Vieussenii). Its right portion separates the 
right and left halves of the septum. Although it does not project at 
its lower part, it is however complete in this place also. 

We observe in its circumference several openings of the cardiac 
veins, called the foramina of Thebesius (foramina Thebesii). At the 



200 DESCRIPTIVE ANATOMY. 

lower end of the inferior edge of the ring a circular fold of the inner 
membrane of the right auricle commences, this is called the Eustachian 
valve, or the anterior valve of the foramen ovale (ralvula Eustachii, s 
foraminis oralis antericr).(l) This fold extends more or less to the 
right, along the anterior part of the orifice of the vena cava ascendena 
into the right auricle, so that its lower edge is concave and attach) d 
while the upper is convex and loose within the right auricle. It im- 
perfectly separates below the right and left halves of the right auricle! 

This valve varies much in regard to size, form, and texture, It is 
usually more perfect and proportionally larger in the fetus than at any 
time after birth. In the adult it is often entirely changed, at leas) at 
its upper part, into a reticular tissue, and in many cases some filaments 
only trace the valve, and these frequently do not exist. It usually 
contains some muscular fibres, but it is often only a simple fold of the 
internal membrane. 

An intimate relation generally exists between the Eustachian valve 
and the fossa ovalis, the former being more developed in proportion as 
the septum formed by the latter between the two auricles is less per- 
fect, and vice versa ; but to this rule there are numerous exceptions. 

The valve acts principally in the fetus. At this period of life it con- 
ducts the blood of the vena cava superior toward the opening of the 
septum or the foramen ovale. Hence the relation between it and the 
valve of this opening. 

In the adult it may prevent to a slight degree the reflux of the blood 
from the vena cava superior, and from the right auricle generally into 
the vena cava inferior. Directly at the left side of the left branch of 
the isthmus of Vieussens, between this branch and the venous orifice 
of the right ventricle, there is a large and rounded opening, the orifice 
of the large coronary vein of the heart (orificium vence coronarite cordis 
magna). (2) This opening is sometimes divided more or less distinctly 
into several, and generally is more or less perfectly closed by a valvular 
fold, which arises at its lower part. This fold, called the valve of The- 
besius (valvula Thebesii), has its upper and concave edge unattached, 
while its lower and convex edge adheres. Sometimes it does not exist ; 
in other cases it is replaced by one or more imperfect transverse bands ; 
finally, in some subjects there are several, even as many as six, situated 
one behind another. 

(1) Winslow, Description dune valvule singulicre cle la rcine cave infericure, a 
I'occasion de laquelle on propose un sentiment nouvcau sur la famcusc question ciu 
trou ovale, in the Mem. de Paris, 1717, p. 272. Eclaircissemcnt sur un Mem. de 1717, 
Ibid. 1725. — Haller, De valvula Eustachii, Gottingen, 1737. — L. Crell, De valvula 
vence cavce Eustachiand, Wittenberg-, 1737.— Brendel, De valvula Eustachiand inter 
venam inferiorem dextramque cordis auviculam positd, Wittenberg, 1738. — Haller, 
De valvula Eustachii pvogr. ii. Gottingen, 1748. — J. M. Diebolt, Deforaminc ovali, 
Strasburg-, 1771. — J. F. Lobstein, De ralvula Eustachii, Strasburg-, 1771.— C. F. 
Wolff, De foramine ovali ejusque usu in dirigendo sanguinis motu observationcs 
■novae, in the N. C. Petrop, vol. xx. p. 357.— H. L. Leveling, De valvula Eustachii ct 

fovaminc ovali, in the Obs. anat. rarfasc. i. 1786. 

(2) Wolff, De orificio vena: coronarioe magnce ; in the Act. Petrop. 1777, p. 234-257. 



ANGEIOLOGY. 201 



II. PJGHT VENTRICLE. 



§ 1306. The anterior, pulmonary, or right ventricle (ventricidus an- 
terior, s. dexter, s. pulmonalis) is composed of an upper and lower por- 
tion, which are separated by the upper part of the venous valve. The 
former unites directly to the right auricle, the latter to the pulmo- 
nary artery, and its walls are thinner than those of the former. It 
terminates in a conical extremity, which projects upward and backward 
above the left ventricle and the septum of the heart. The pulmonary 
artery arises from this part. 

The internal or posterior wall is formed by the septum of the heart 
and is slightly convex ; the anterior is still more so. The posterior 
wall is smoother than the anterior at its upper portion and very often 
entirely so below the arterial opening. The net -work formed by the 
projecting muscular fasciculi is much more complete toward its sum- 
mit than toward its base. 

The anterior wall of the pulmonary ventricle is thinnest above toward 
the septum and thickest below also near the septum. Its thickness 
when the heart is strong and not very much distended is more than 
two lines, but less than this in the latter point. The two parts are 
scarcely a line thick even in those hearts which are neither very much 
distended nor small. 

The quantity of blood in the right ventricle after death varies from 
one ounce and a half to three ounces. 

§ 1307. The venous valve of the right auricle arises from the cir- 
cumference of its venous orifice. It is called the tricuspid valve (val- 
tula trio-lochis, tricuspis), because, although it forms a single membrane, 
it is higher in three points than in the short spaces between them, and 
thus three slips are formed. 

Of these, one, which is the largest, arises from the external and an- 
terior part of the circumference of the venous orifice. The other two 
are smaller and arise from the inner and posterior part of this circum- 
ference, one over the other ; so that consequently there is an external 
and larger slip, and two internal, an upper and a lower slip. 

The last two are separated from each other by a space not so deep 
as those between them and the external. It is then more correct to 
admit only two slips, an anterior and external and a posterior and 
internal. 

The first is much higher than the second. 

The tendinous filaments of the upper extremity of the anterior or 
external slip are attached to this upper part of the septum. They are 
few in number. We usually find in the space only one or at most two 
short muscles, to which are attached those filaments farthest to the 
left ; the others are inserted in its smooth wall. Most of those 
filaments which come from the central and lower parts of the edge of 

Vol. II. 26 



202 desciuttive anatomy. 

this slip are attached to the summits of five or six of the fleshy pillars 
coming from the middle and lower parts of the anterior wall. 

The filaments which arise from the posterior slips are mostly attached 
to the smooth folds of the septum, except a few, which are inserted in 
two or three small fleshy pillars, all of which except the lowest come 
from the septum. 

The arterial orifice generally extends about three fourths of an inch 
higher than the venous. The sigmoid valves are thin. Their tubercles 
(noduli Morgagnii) are slight swellings, which however are often well 
marked in the young fetus. 

III. LEFT AURICLE. 

§ 1308. The left, posterior, or pulmonary auricle {atrium sinistrum, 
6. posterius, s. venarum pulmonalium, s. aorticum) is of an oblong square 
form, considerably more broad than high. 

It is separated below and posteriorly from the left ventricle by a circu- 
lar groove, upward and to the right from the right ventricle by a similar 
depression. The pulmonary artery, the aorta, and the vena cava superior 
are also found upward and outward, between it and the right ventricle ; 
so that the external part of its right and left extremities is alone visible. 

Its upper left angle rises into an auricular appendage (auricula sinis- 
tra), which goes forward to the left and upward, directly behind the 
pulmonary artery, separating very much from the rest of the auricle. 
This appendage, which is narrower, longer, and on the whole larger 
than that of the right auricle, is circumscribed by rougher edges. It 
curves three or four times and finally terminates in a sharp summit, 
below and before the pulmonary artery. 

The posterior wall of the lower part, the sinus of the auricle (sinus 
venarum pulmonalium), receives where it is continuous with the lateral 
parietes the four pulmonary veins, two on each side, the upper being 
larger than the lower. One of the two veins of the same side opens 
directly above the other, while between those of the two opposite sides 
is the whole breadth of the auricle ; so that the two pairs occupy the 
whole height of the posterior wall. 

The parietes of the whole auricle are muscular and formed principally 
of transverse fibres. The}'- are smooth with the exception of the ap- 
pendage. We observe in its whole length an anterior and a posterior 
series of very prominent transverse fasciculi, united by other smaller 
and oblique fasciculi, which proceed between two longitudinal bands, 
situated one on the right the other on the left. 

The anterior wall is formed by the septum of the auricles and is also, 
like the posterior face of the septum, irregular in another respect. In 
fact we there observe a constant semicircular valve, which is however 
more or less developed. This valve leaves the upper edge of the trans- 
parent point which corresponds to the fossa ovalis of the right auricle 
(§ 1305). It is turned upward and toward the left. Its lower edge 



ANGF.IOLOGY. 203 

is convex and attached, and its upper edge is loose in a greater or less 
extent. Sometimes there is only a slight projection in its place. 

This valve extends behind the interauricular septum. Its lower edge 
is attached to the posterior face of the centre of the isthmus of Vieus- 
sens, and the space between it and this isthmus forms a small cavity 
(sinus septi), which terminates below in a cul-de-sac. This is onhy the 
upper part of the valve of the foramen ovale (§ 1305), which in the 
normal state always ascends on the posterior face of the isthmus. Of 
this we are readily convinced when it does not adhere to the isthmus 
in the centre ; for then the continuity is totally uninterrupted. 

IV. LEFT VENTRICLE. 

§ 1309. The left ventricle (vcntriculus sinister, posterior, s. aorticus) 
is the strongest of all parts of the heart and forms its figure. Its pos- 
terior wall and its anterior wall which forms the posterior face of the 
septum, are convex externally and concave internally ; so that its whole 
form is oval. The internal face of the posterior wall is very much 
reticulated ; the anterior wall is smooth at its upper part and reticulated 
in the lower, but less so than the posterior wall. The fleshy pillars 
are rounded. 

The thickness of the parietes is less toward the summit and greater 
at the base than in all other parts. In the adult it is five or six fines 
thick at the base and only three at the summit. 

The capacity of the left ventricle varies in the adult from eight to 
twenty drachms. 

§ 1310. Before the round venous orifice we find the mitral valve 
(valvula mitralis), composed of an upper and a lower slip. The upper 
arises directly below or rather before the ring of the sigmoid valve of 
the aorta, and is attached by slips to three or four flest^ pillars, which 
all come from the internal face of the posterior wall of the ventricle, some 
above, others below, and among which we distinguish two particularly, 
an upper and a lower, which are much larger than the others. The 
inferior and external slip, which is much narrower, is attached by ten- 
dinous filaments to a short but very thick fleshy pillar. 

All these fleshy pillars arise from the posterior wall of the left ven- 
tricle ; so that those of the upper slip arise near the summit of the 
heart, and cover those of the lower, so that we cannot perceive the 
lower slip until we have removed the upper or have detached it from 
its fleshy pillars. 

The orifice of the artery is situated directly over that of the vein. Its 
sigmoid valves are thick and are generally supplied with tubercles 
(noduli Arantii), which are very distinct. 



204 DESCRIPTIVE ANATOMY. 



V. SEPTUM. 



§ 1311. In the normal state the septum of the heart completely 
separates its two halves, even when the valve of the foramen ovale is 
not united with the isthmus of Vieussens at its upper part. In the 
venous portion of the heart it is much thinner than the auricles, which 
it separates, and is much lower, as they project above it. It is not muscu- 
lar in every part, and generally there are no muscular fibres in the upper 
part of the old valve of the foramen ovale. 

In the arterial portion, on the contrary, the septum is very muscular 
and is formed almost entirely by the fibres of the left ventricle. It projects 
considerably into the right ventricle, while in its posterior face, which 
forms the anterior wall of the left ventricle, there is a deep depression. 
Its height equals that of the ventricles. It is triangular and terminates 
in a point toward the summit of the heart. It is generally from four to 
five lines thick, and even more than a half an inch thick in those parts 
where the large fasciculi project above the surface in those subjects 
which have large hearts. It is thickest below the orifices of the large 
arterial trunks, and thinnest beyond this point toward the interauricular 
septum. It is almost always weaker at the summit, where the layers 
which constitute it are less compact and more easily separated from 
each other. 



CHAPTER III. 

OF THE PERICARDIUM. 

§ 1312. The pericardium (pericardium) (§ 1293)(1) is a fibro-serous 
membrane (§ 354), which entirely envelops the heart and the origin 
of the large vessels, and unites them with the adjacent parts. 

The fibres which strengthen its outer layer and which are very ap- 
parent in old men, arise from the central aponeurosis of the diaphragm 
and extend longitudinally over the serous membrane. They are very 
much developed, particularly forward and upward. 

Its lower face, which corresponds to the lower and flat face of the 
heart, is intimately united to the upper face of the central aponeurosis 
of the diaphragm by a very short cellular tissue. 

It is covered on the sides and forward by the inner walls of the 
pleura?. 

Behind, it is attached to the esophagus and to the root of the right 
lung. 

(1) J. M. Hoffmann, Diss, de pericardio, Altdorf, 1690.— A. B. Hcimann, De peri- 
car dio sano et morboso, Leyden, 1729. — Lanzoni, De pericardio ; in Opp. omn., Lau- 
sanne, 1738. 



ANGEIOLOGY. 205 

<§ 1313. The pericardium incloses not merely the heart but also the 
origins of the large vessels, whence it is reflected on itself in every 
direction to arrive at the centre of the heart. 

When examined from before backward and from above downward, 
we notice the following arrangement : 

It envelops the aorta and the trunk of the pulmonary artery forward 
for about two and a half inches, unites these two vessels very closely, 
and passes uninterruptedly from one to the other ; so that the corre- 
sponding parts of their circumference are retained by a cellular tissue. 

The posterior part of these vessels is not covered in the same extent 
by the pericardium. 

From the aorta this membrane passes to the right on the vena cava 
superior, to about an inch above its entrance into the right auricle, de- 
scends obbquely from left to right on its anterior portion, then arrives 
at the right pulmonary veins, on which it descends to about half an inch 
from their entrance into the left auricle, then goes on the anterior part 
of the vena cava inferior, directly below its opening into the right au- 
ricle, and wholly surrounds it except a small part of its posterior por- 
tion. yThence it goes to the left, on all the surface of the left pulmo- 
nary veins, and finally covers the left branch of the pulmonary artery 
below. 

From all these parts the pericardium is reflected on itself. It adheres 
feebly to the large vessels, but much more strongly to the auricles and 
ventricles. 

As in all other serous membranes, the inner and reflected portion of 
the pericardium is thinner than the external. It closely envelops the 
surface of the parts inclosed by the membranous sac, and, except in 
those parts Avhere it is reflected, it is entirely separated from the outer 
layer, although they touch ; so that the circumference of the heart is 
perfectly loose and is attached only by its upper part. 



CHAPTER IV. 

OF THE DIFFERENCES OF THE HEART WHICH DEPEND ON THE 
DEVELOPMENT AND ON THE SEX. 

§ 1314. The differences presented by the heart in regard to its de- 
velopment are considerable.(l) They relate to its volume, situation 
form, and texture. 

1st. Volume. The heart is much larger in proportion to the body in 
the early periods of life than at a more advanced period. The relation 

(1) The principal works on this subject arc mentioned in Danz, Grundriss der 
Zergliederungskunde des ungcbornen Kindes in den verschiedenen Zeitcn der 
Schwangersckaft, vol. ii. Giessen, 1793, p. 185-188.-See also Meckel. Memoirc sur le 
developpement du cceur ; in the Journal complementaire, vol. i. p. 259.— Rolando 
Memoire sur la formation du cosur ; same journal, vol. xv. p. 323, vol. xvi. p 34 



206 DESCRIPTIVE ANATOMY. 

between it and the body is as 1 : 120 in the full grown fetus and in 
the early years of life, while before this period, in the second and third 
month of pregnancy, it is as 1 : 50. 

2d. Situation. At first the heart is not oblique, but its summit looks 
directly forward and a little downward. It is only at the fourth month 
that it begins to turn slightly toward the left side. 

3d. Form. The differences in its form are the most important and 
relate both to the circumference of the whole organ and to the mode of 
limiting its cavities. Observers have not decided whether there is or 
is not in the human fetus a period very near its origin, when the heart 
forms only a single cavity, composed of several compartments placed 
near each other. But if this period exists, it passes rapidly, since all 
the external parts are developed in the fetus at the end of one month. 

A. OUTER CIRCUMFERENCE. 

a. At first the arterial portion of the heart is much smaller in propor- 
tion to the venous. The right auricle especially remains for a long 
time the largest portion of this organ. The permanent relation how- 
ever begins to establish itself during the last half of uterine existence. 

b. The arterial portion is at first fiat and rounded : soon however its 
breadth exceeds its length. Its summit is at first single and blunt ; but 
as it enlarges it bifurcates. This phenomenon depends on the fact that 
the right ventricle from its situation does not at first concur to form the 
summit of the heart ; but it gradually extends downward and remains 
separated from the left ventricle by a considerable depression. This 
groove sometimes continues during life, but almost always disappears 
after the middle of uterine existence. 

c. The right ventricle is at first much smaller than the left : they 
are soon equal in size : for a certain time the right ventricle is even a 
little larger, but it becomes smaller during most of uterine existence ; 
so that it is narrower in the full grown fetus and in the young child. 
The greater size of the right ventricle seems to result from the obstacles 
which often disturb the pulmonary circulation at an advanced period 
ofhfe.(l) 

(1) This at least has been observed by Portal (Stir la capacite des ventricules du 
cosur ; in the Mem. de Paris, 1770, p. 244-246). In the heart of a full grown fetus 
the left ventricle contained seven drachms of water, while the right contained only 
six and a half. The capacity of the two ventricles was the same in that of a young 
child; in that of an adult the right ventricle contained eighteen drachms of water, 
and the left only seventeen. The experiments of Legallois (Diet, dessc. med. t vol. v. 
p. 440,) prove that we can introduce 

grs. of mercury 
i j,, u < Into the rierht ventricle, 1172 

lnanadult > Unto the left ventricle 1068 

f Into the right ventricle, 828 
,.,, ) Into the left, not softened 

In a child, 1 by pressure, - - 658 

( Into the left, softened, 822 



ANGEIOLOGY. 



207 



d. In the early periods of life the upper and pyramidal extremity of 
the upper part of the pulmonary ventricle is less distinct from the rest 
of the organ than at more advanced periods : it elevates itself also less 
above the left ventricle and the septum. This peculiarity is very curi- 
ous, as precisely the contrary is seen in many mammalia, especially 
the ruminantia and the hog. 

B. INTERNAL ARRANGEMENT OF THE HEART. 

The principal difference presented by the heart in this respect is, that 
its septum is imperfect in the early periods of life, whence its right and 
left portions then communicate with each other. 

a. The interauricular septum is perforated during all fetal existence 
by an opening called the foramen ovale. This foramen is much greater 
as the fetus is younger ; so that we may consider the septum as primi- 
tively deficient and the two auricles then form a single cavity. The 
foramen ovale gradually grows smaller and occupies the lower and cen- 
tral part of the septum. The Eustachian valve is found very early di- 
rectly before it and on the right, so as to occupy all its height. Hence as 
it arises from the anterior part of the circumference of the vena cava in- 
ferior, it separates the right and left auricle in such a manner, that this 
vein empties directly into the left auricle only. On the contrary, there is 
no trace of the closing of the foramen ovale on the left side till the com- 
mencement of the third month. But about this period this foramen begins 
to be obliterated by the formation of its valve, which arises from the 
posterior part of the vena cava. 



In a still-born child, 



grs. of mercury 
f Into the right ventricle, 34 
i Into the left ventricle, 



In a seven months' fetus, 



In another about the same age, 



not softened, 
(_ Into the left, softened, 

C Into the right ventricle, 
< Into the left, not softened 
I nor flaccid, 

{ Into the right ventricle, 
( Into the left, softened, 



37 
78 

23 

34 

21 

54 



In repeating these experiments, also with mercury, we have obtained the following 
results: 



In a man 50 years old, - 

In a woman 46 years old, 

In a woman 40 years old, 

In a man 34 years old, - 
'< 30 - 

" 26 " - - 

In a boy 16 " - 

In a girl 7 months old, - 

In a new born boy which had breathed, 

In a still-born boy, 



R. ventricle 


L. ventricle 


L. auricle 


R- auricle 


oz. 


drs. 


oz. 


drs. 


oz. drs- 


oz. drs. 


30 




10 




25 


20 


40 




22 


4 


22 


15 


55 




40 




41 


35 


32 




15 


4 


21 


25 


32 


4 


28 


4 


25 


22 4 


28 




20 


4 


20 


18 


41 


4 


21 


4 


37 


29 


2 


4 


1 


4 


1 4 


1 6 


1 


6 


2 




1 6 


1 2 


1 


4 


2 




together 


4 ounces. 



208 DESCRIPTIVE ANATOMY. 

As this enlarges, the Eustachian valve diminishes and recedes from 
the septum, while on the contrary that of the foramen ovale approachea 
it. The latter also becomes narrower and more tense, especially in the 
latter months of pregnancy ; so that it closes the opening more exactly. 
The termination of the vena cava inferior in the heart suddenly changes, 
and this vessel empties itself no longer into the left auricle but into the 
right. This change is also favored by that which takes place in the 
situation of the heart, which varies so that its summit corresponds 
to the left ; the right auricle is more than usually elevated above the 
vena cava inferior, at the same time that the Eustachian valve is re- 
moved from the septum and is carried forward. 

The valve of the foramen ovale increases from below upward along 
the lateral edges of this foramen. At the sixth month of pregnancy it 
has already arrived at its upper part ; it then passes beyond it ; so that 
the interauricular septum is entirely filled, except a small space, which 
is no longer an opening but a very short canal, formed forward by the 
upper part of the ring of the foramen ovale and backward by the upper 
part of the valve. 

b. It is not yet well demonstrated whether the ventricles, like the auri- 
cles, form at first only a single cavity without a septum, although the 
development of the heart in the animal series, and the deviations of 
formation of this organ lead us to this opinion. We have always 
found a trace of the interauricular septum at the summit of the heart, 
even in the youngest fetuses we could examine. During the first two 
months however, or at least till the middle of the second, this septum 
presents at its upper part a foramen, at first rather large, but it gradu- 
ally diminishes, and is found below the origin of the large vessels, so 
that the two ventricles form only one, which is imperfectly divided 
into two portions. This opening is obliterated at the period when the 
artery which arises from the ventricles becomes double, instead of 
single, as it was at first ; that is, when the pulmonary artery, which 
before was blended with the aorta, becomes a proper and distinct 
vessel. Its obliteration then much precedes that of the foramen ovale. 

4th. Texture. The thickness of the parietes is much greater com- 
pared to the size of the cavities during the early periods of life than 
subsequently, and the greatest size of the heart then depends on this 
cause. (1) 

The parietes on both sides are then equally thick. The difference 
which always exists afterwards, and which is scarcely perceptible even 
in a full grown fetus, does not begin to be developed till the second half 
of uterine existence. 

The fibrous texture and the different layers of fibres are always 
more apparent at the early periods of life than at a more advanced age. 

(1) Gordon is mistaken in saying- that the parietes of the heart are proportionally 
thinner in the early periods of life than at a more remote period (System of human 
anatomy, vol. i. p. 53.) 



angeioloGy. 209 

"5th, Color. The color of the heart is much brighter when the 
subject is younger. 

No fat has as yet accumulated on the surface of this organ in the 
early periods of fetal existence ; but this is generally the case with all 
parts of the body. 

The pericardium is then proportionally thicker than at subsequent 
periods, and its internal or reflected layer adheres less intimately to the 
heart. 

C. SEXUAL DIFFERENCES. 

§ 1315. The only sexual difference seen in the heart is that it is 
proportionally a little larger in males. 



CHAPTER V. 

MOTIONS OP THE HEART. 

^ 1316. The circumstances in the history of the motions of the heart, 
cr in the heart in its active state, which deserve examination, are, 

1st. The changes in its form. 

2d. The succession and simultaneousness of the motions in its 
different parts. 

3d. The relation between the cavities of the heart in its different 
states and the blood. 

4th. The number of its motions. 

5th. The changes in its situation. 

6th. The duration of its motions. 

7th. The conditions on which they depend. 

§ 1317. 1st. The heart diminishes in contraction and enlarges in 
dilatation in every directional ) 

2d. The auricles and ventricles contract and dilate alternately, so 
that the two auricles and the two ventricles execute the same motions 
at the same time. (2) The auricles in contracting send the blood into 

(1) Sur le changcmcnt du figure de cceur dans le style, in the Mem. de Paris. 1731 
hist. p. 33, 40. ' ' 

(2) The motions of the heart have been carefully analyzed by Laennec with the 
aid of the stethoscope, by which we can study them more correctly than by opening 
and inspecting living animals (De V auscultation mediate, vol. ii. p. 195-227). Prom 
this analysis are deduced numerous important practical facts. 

In the motions of the heart we must consider their extent, its impulse, the nature 
and intensity of the sound and the rythm, according to which the different parts of 
the organ contract. 

1st. Extent. In a healthy and moderately fleshy subject, the pulsations of the 
heart are heard only in the space between the cartilages of the fifth and sixth true 
ribs, and under the lower part of the sternum. Those of the left cavities correspond 
principally to the first point, and those of the right to the second. If the sternum is 
short, we hear the pulsations in the epigastrium also. When the subject is sp Cat that 

Vol, II. 27 



oiu DKSCKJI'TIVE 4Ni.XOMl 

ihe ventricles, which then contract on it, and throw it into the arteries 
at their base. A small quantity of the fluid however always returns 
tiom the arteries into the ventricles, from these into the auricles, and 
thence into the veins which open in^o them. 

3d. The cavities of the heart are almost entirely empty when they 
contract. However a little blood always remains, which is attached 
especially to the reticulated surface of their inner face. 

4th. When the ventricles contract the apex of the heart beats 
against the anterior wall of the chest, notwithstanding that the organ 
shortens. This arises principally because that the auricles are then 
filled, both by the blood disgorged by the veins and by that which 

t hey cannot be felt by the hand, the space in which they can be heard by the stethoscope 
is sometimes only about a square inch. In thin persons, when the chest is narrow, 
and even in children, they always have more extent. They may be heard in the 
lower third, or even in the three lower fourth?, of the sternum; sometimes also, under 
all this bono, at the left anterior and upper part of the chest to near the clavicle, and 
- sometimes, but less manifestly, under the right clavicle. The subject rarely enjoys 

frerfbet health when the extent of the pulsations exceeds these limits, so that they are 
icard in the left side of the che3t, from the axilla to the region corresponding to the 
stomach ; and to a similar extent on the right side, at the left posterior part of the 
chest ; finally, on the right posterior part, a successive progress, which would seem 
tfi be constant, and which is attended with a progressive diminution in the intensity 
of the sound. In this respect we may state as a principle, that the extent of the heart's 
pulsations is directly as the feebleness and the thinness of its parietes, especially those 
of the auricles, and inversely as their force and thickness. 

2d. Impulse of 'the heart. In contracting, the heart gives a sensation of percus- 
sion, raising or repelling the hand, or any other part placed upon the anterior walls 
of the thorax. In some individuals this impulse is visible, and sometimes causes a 
very extensive motion, which raises the parietes of the chest, the epigastric region, 
and even the clothing. It is however but slightly marked when the proportions of 
the heart are normal, and is often imperceptible in fat people. It is perceptible only 
during the systole of the ventricles. If the contraction of the auricles sometimes 
produces a similar phenomenon, it may be distinguished from the first, inasmuch as 
most generally it consists only in a kind of rumbling, which is heard very deeply in 
the mediastium. This impulse is generally perceptible only between the cartilages 
of the fifth and sixth true ribs, or, at most, in the lower half of the sternum, and in 
some subjects, when the sternum is very short, in the epigastrium. Generally speak- 
ing, it is inversely as the extent of the pulsations, and directly, as the thickness of the 
ventricles. 

3d. Nature of the sound. On listening attentively we distinguish during the pul- 
sations of the heart two distinct sounds: one, duller and continued ; the other, quicker, 
and more distinct. The first is simultaneous with the pulsations of the arteries and 
marks the contraction of the ventricles; the second is caused by the contractions of 
the auricles. That heard at the lower part of the sternum belongs to the right cavi- 
ties j ' hat distinguished between the cartilages of ;the fifth and sixth ribs depends on 
the left cavities. In the normal state, this noise is similar and equal on both sides; 
and is no where so loud as in the precordial region. It is as much stronger as the 
parietes of the ventricles are thinner, and as the power of impulse of the heart is less. 
4th. Rythm The duration of the sound caused by the auricles is shorter than of 
that produced by the ventricles; hence, the contractions of the auricles do not con- 
imuc as long as those of the ventricles. There is a well marked but short interval 
ol rest between these two sounds- This observation proves that the heart, like all other 
muscles, is alternately in a state of action and of rest. We may admit, that of the 
twenty-tour hours, the ventricles have twelve and the auricles eighteen hours of rest ; 




or even a quarter, is occupied by the systole of the auricles ; a fourth, or a little lew 
by absolute rest, and a little more than a half bv the systole of the ventricles. F. T 



ANGEIOLOGV. 211 

flows back from the ventricles, so that the latter are pushed forward ; 
but it depends also a little on the extension of the arterial trunks at the 
moment when the arterial blood which is sent from the ventricles 
passes through them.(l) From not attending to these last two cir- 
cumstances it was for a long time impossible to explain the pulsations 
of the heart during its contractions, except by admitting that it length- 
ened in performing this motion, which is very improbable. 

5th. The mean number of pulsations of the heart in the adult is 
seventy per minute. But it varies much according to the individual. 
The pulsations are generally more feeble and fewer in the female 
If we except the early periods of life when the contractions of the 
heart are few, the number of its pulsations is much greater the nearer 
it is to the period of its formation. 

6th. We generally consider the heart as that part in which irrita- 
tability continues the longest. But it follows from the observations of 
Haller, Zimmerman, and Oeder, that there are exceptions to this law ; 
and the observations of Fontana, Creve,(2) and Nysten,(3) with which 
our own agree, demonstrate that this is not true, at least to the arterial 
portion, since the ventricles lose their irritability before the other mus- 
cular parts of the body ; but the auricles preserve it the longest,(4) 
and that the right auricle remains irritable longer than the left. Hal- 
ler has attempted to prove that this latter difference depends on the 
circumstance that the right auricle is stimulated longer by the blood 
within it,(5) but we have often seen it in hearts which were removed 
from the chest and totally destitute of blood. Nysten has observed 
it also in persons who were beheaded. We then have reason to say 
it depends on the greater tenacity of life in this part of the heart, and 
the more as the tenacity increases in animals in a direct ratio with the 
predominance of the venous system in them. 

7th. The conditions of the action of the heart are the same as those 
of muscular action generally. For this then we refer to the details 
already mentioned in the first volume. 

(1) When the ventricles contract, the point of the heart strikes the left lateral Wail 
of the chest, between the cartilages of the fifth and sixth ribs. The two causes men- 
tioned by the author, the filling of the auricles and the extension of the trunks of tlr^ 
arteries, doubtless contribute to produce this phenomenon; but we may admit al^ 
that while the ventricles contract, their moveable point rises, and performs the motion 
of a pendulum on the base of the heart, which, being more fixed, serves as a point of 
support. F. T. 

(2) Vom Metallreize, Lcipsic, 1796, p. 100. 

(3) Rccherchcs dcphysM. et de chimie, Paris, 1311, p. 307. 

(4) As Davy observed in experiments for another purpose. See his Researches tm 
mtrous oxide, London, 1800, p. 352. 

la nato, in the CMwm. Gntt.. vol. i. 



21 2 UESLCRIPTIVE ANAlYOri 

CHAPTER VI. 

OF THE HEART IN THE ABNORMAL STATE. 

§ 1318. The anomalies of the heart are divided into two sections, 
according as they affect the form or the texture of this organ. We 
."hall mention here only the first, having spoken of the latter in the 
fast volume, when treating of the alterations in the texture of the 
vessels, of the muscles, and of the serous membranes. 

§ 1319. The deviations in the formation of the heart embrace ano- 
malies which may exist in number, situation, volume, and figure. 

§ 1320. In regard to number, the heart may vary from the normal 
state in two opposite modes, that is, may be either wholly or partially 
deficient, or may have supernumerary parts. 

The heart is entirely absent only when the upper half of the body 
Is very imperfectly developed, and the head is then usually deficient. 
However, this rule presents but rarely exceptions of two kinds : for, first, 
the heart sometimes appears when the head does not exist ;(1) and 
secondly, this organ is sometimes wholly(2) or partly deficient(3) 
in monsters where the trunk and head are not very much deformed. 
We shall speak of the partial absence of the heart hereafter. 

The plurality of the heart, the body being simple, is infinitely more 
rare, however common it may be when the body is double, but is not 
seen constantly even in the latter case. We know of but one instance of 
a perfect plurality of the heart where the body was single. We are 
led to this anomaly by the fissure of the ventricles and by the conge- 
nital existence of abnormal and hollow appendages to the heart. (4) 

§ 1321. The anomalies in the situation of the heart are congenital 
or accidental. In the first case the organ exists sometimes within, 
and sometimes outside of the cavity of the thorax. 

When found in the chest it may be, 

1st. Straight, and then either perpendicular, or horizontal, or finally 
placed so that its summit looks upward. (5) 

2d. Reversed, having its base to the left and its summit to the 
light, an anomaly which exists singly or which is attended with the 
more or less perfect inversion of the other organs. (6) 

(1) Wc have collected all the instances of this anomaly in our llandbuch dcrpatho- 
Urgischen Anatomie, vol. i. p. 165. 

(2) See our Handbuch dcr -path. Anat., vol. i. p. 414. Besides the cases there men- 
tioned, two have been published since; one by Brodie (Phil. Trans. 1811), and the 
other by Lawrence (Med. Chir. Trans.), vol. v. 

(3) Rcederer, in the Comment. Gott., vol. iv.— Meckel. Handb. dcr path. Anat., vol. 
i. p. 421. r 

(4) We have collected all the cases of this anomaly in Meckel, Dc duplic. monslrosa. 
p. 53, and Handb. der path. Anat., vol. ii. p. 33-45. 

(5) Meckel, Handb. der path. Anat-, vol. i. p. 418.— Bertin in his work has figured 
a heart which was situated transversely in the cavity of the thorax. 

(61 One case of this kind now before us has been figured in Meckel. De covditionihm 
"n-.-rUmbnorv+.i Hallo. 1R03. vol i 



ANGEIOLOGY. 213 

3d. Deeper than usual.(l) 

When it exists out of the chest two cases are possible. 

1st. The anomaly being slight the heart hangs loosely outward, 
either in its usual place(2) or higher than it is generally, in the cervical 
vegion.(3) In this case the pericardium is usually but not always 
deficient. On the other hand it sometimes but very rarely happens 
that this membrane is not found even when the heart is situated in the 
chest, and then it is replaced by the pleura.(4) 

2d. The anomaly existing in a greater degree which is also still 
more rare, the heart is found in the abdomen,(5) a deviation of formation 
to which the very sloping situation of this organ in the pectoral cavity 
leads. 

The accidental anomalies in the situation of the heart depend on 
the accumulation of solids or liquids within the chest or the penetra- 
tion of foreign bodies there, and follow no constant and fixed laws. 

§ 1322. Anomalies in the volume of the heart are congenital much 
less frequently than accidental. They however sometimes have the 
character of a primitive formation, and are even hereditary in many 
families. The heart is then too small or too large. We often find 
both of these anomalies in the different parts of the same heart. 

The smallness of the heart(6) is much more rare than its excess in 
volume. It is often earned to an extreme point although the forma- 
tion of the organ is unchanged. (7) 

As to the excessive size of the heart, we must distinguish the pure 
find simple increase in its mass, the thickening of its parietes,(8) from 
the thickening of its parietes with an increase in its capacity,(9) and from 
its simple dilatation or an increase in its capacity (10) with or without 
a thinness of its parietes, since we find all these states sometimes insu- 

fl) Meckel, Handb. derpath. Anat., vol. i. p. 417. 

(2) Id. Ibid. vol. i. p. 406. 

(3) Id. Ibid. vol. i. p. 98, 99. 

(4) See our Handb. der path. Anat., vol. i. p. 110. 

(5) Deschamps has mentioned an instance of this in Sedillot, Rccucil periodique, 
vol. xxvi. p. 275-279. 

(6) We have mentioned several cases in our Handb. der path. Anatomic, vol. i. p. 
470-472. 

(7) Consult also, on the wasting- of the heart, Laennec (De I'ausc. Med. vol. ii. p. 
291), and Bertin (Des mat. du cwur, p. 387). The latter admits two kinds ; one where the 
walls of the heart are collapsed, the other where the same parietes, especially those 
-of the ventricles, are, on the contrary, dilated, and at the same time become thinner ; 
this is the state termed passive aneurism. F. T. 

(8) Different instances of the simple increase of the mass of the heart have been 
reported by Vetter, Aphorismen aus der pathologischen Anatomie, p. 99. — Legallois, 
in the Bullet de VEc. dc Med., 1813, 1814, p. 69.— Morgagni, Ep. anat. med., 30 to 
20.— Burns. 

(9) We find several cases of it in Morgagni, Epist. anat. 18 to 28, and 30.— Corvi- 
sart, Malad. du cwur. p. 61. 

(10) Many instances of this anomaly are mentioned in Burns. — Morgagni, Epist. 
anat., 18 to 2, and 14.— Dundas, On a peculiar disease of the heart, in the Med. sure. 
Trans., vel. i. p. 37. 



214 DESCRIPTIVE ANATOMY. 

lated and sometimes united.(l) The last two are termed aneurisms of 
the hbart, which in the first case is called active, and jmssive m the 
second. The active aneurism is more common on the left side and 
the passive on the right. These two states usually coexist, the left 
side being dilated actively, and the right side passively, to a greater 
or less degree. (2) Sometimes the parietes of the left side have only 
become thicker, and those of the right side are on the contrary 
thinner, with or without dilatation at the same time. (3) However 
it often happens that one part or the other is diseased, each in its 

(1) This distinction neglected by Corvisart who understands by the terms active 
aneurism and passive aneurism only a dilation of the heart with a thickening or thin- 
ness of its parietes, was made by Bertin in 1811, in a memoir presented to the Insti- 
tute. Bertin admits three distinct/orms of hypertrophy of the heart, that is, of its 
total or partial fleshy thickening - : 1st, simple hypertrophy, in which the cavities of 
the organ preserve their natural capacity, at the same time that the parietes are 
more or less thickened : 2d. aneurismal hypertrophy, in which the cavities are dilated 
and the parietes are thickened ; this is the active aneurism of Corvisart : 3d, concen- 
tric hypertrophy, in which the thickening- of the parietes is attended with a greater 
or less contraction of the cavities. He also distinguishes two kinds of aneurismal 
hypertrophy ; one in which the parietes are thickened, and the other where the pari- 
etes preserve their natural thickness, so that the increase takes place in some mea- 
sure according to the extent and the circumference, or according to the surface. He 
has also remarked, that in the hypertrophy of the ventricles the thickness often dimi- 
nishes from the base to the point, but it is sometimes about the same at the point as 
at the base, and in some cases is more marked in its centre, and diminishes toward 
the point and even toward the base. It may be equal to fifteen lines, and more, 
although Laennec asserts that it never exceeds four or five lines. Sometimes we 
find in the same ventricles one portion which is dilated and thickened, and another 
contracted and thickened, or one part thin, while the other is thick. We sometimes 
observe a great difference between the parietes of the ventricles, especially on the 
right side, and the fleshy pillars, the latter being doubled or tripled in extent, while 
the parietes are not, or but very slightly, thickened. In other cases, the hypertrophy 
of the leit ventricle seems to take place at the expense of the pillars, which are effaced 
or are hardly visible. The hypertrophy of the left ventricle is generally attended 
with that of the septum. We sometimes observe also a hypertrophy of the inter- 
ventricular septum only. The fleshy pillars of the right ventricle have been found 
so thickened and intercrossed that there was hardly any cavity. Hypertrophy also of- 
ten affects both ventricles at once, but not unfrequcntly they present an opposite state. 
The point of the thickened ventricle always descends lower than that of the other. 
The three forms of hypertrophy are observed in the auricles, but the aneurismal is 
the most common. The thickening is nearly equal in all the extent of the parietes, * 
especially in the left auricle. The muscular fasciculi of the right auricle sometimes 
increase in volume. Finally, in certain cases, the parietes of this auricle arc so 
much thickened in all their parts, that they imitate those of the corresponding ven- 
tricle. Again, whatever may be the form of the hypertrophy, Bertin admits as 
its immediate and proximate cause, an irritation applied to the heart, which increases 
the activity of the phenomena of nutrition in this organ {Dcs maladies du cceur p 
282). He admits also three kinds of dilatation of the heart, or to proper aneurism : 
1st, dilatation, with thickening of the parietes, or aneurismal hypertrophy • 2d dila- 
tation, with thinness of the parietes; the passive aneurism of Corvisart' which is 
more rare than the preceding ; 3d, dilatation of the cavities, they bcin^- of their 
usual thickness, or simple dilatation, which has not hitherto been regarded To 
'^kKnT he adds a fourth, which is doubtful; the mixed dilatation, in 
which the parietes of the dilated cavity are thicker in some parts and thinner in 
others, and of their natural thickness in the rest. {Ibid. p. 368 ) Consult aI«o on 
hypertrophy of the heart, Lallemanu, Observations pour serv ir a l^t oire^de shirr 
sarcoses du cceur, in the Archiv. gen. de mid. vol v p 520 ft *«<«™ ciesliype, 

(2) Morgagni, Ep.anat., an. m. 40to23.-Testa. Mai. 'del cvorr ft c 
?A Morgagm. Ep. anat, m. 30 tr, on. 



XV. 



ANGEIOLOGY 216 

usual manner.(l) The disease does not necessarily effect an entire 
half. Generally, passive aneurism exists only in the right auricle, 
and active aneurism only in the left ventricle, whether these two 
states exist alone, or whether they are both found in the same heart. 
Sometimes however, but rarely, the right side is entirely or partially 
thicker than usual, or at the same time dilated ; and then sometimes 
the left side is also affected and sometimes it is not : sometimes also 
it presents a passive aneurism, or at least its walls have become 
thinner. Perhaps the passive aneurism is still more rarely confined 
to the left ventricle, while all the other parts of the heart are in the 
normal state. (2) 

These affections are confined to one part of the heart only, much more 
generally than they are extended to the whole of it. Nevertheless, if 
we except the active aneurism of the left side, combined with the pas- 
sive aneurism of the right side, which is frequently observed, we some- 
times find hearts which are affected equally in every part.(3) 

. The diseased cavity of the heart is most generally dilated in its whole 
extent. A partial dilatation in the form of a cul-de-sac rarely ex- 
ists. 

The substance of the heart is sometimes, but very rarely, thicker 
in some parts from round excrescences which project on its internal 
face. We know of but one instance of this arrangement, and the 
specimen is in our cabinet. This is still more curious, as it throws 
much light on the formation of the polypi of the heart, which are ex- 
plained with difficulty unless we admit that one or more of these ex- 
crescences are detached from their place of origin. (4) 

§ 1323. The anomalies in the form of the heart relate either to its 
external or to its internal arrangement, or finally to both. 

They are congenital much oftener than accidental. 

§ 1324. The congenital anomalies in the external form are, 

(1) We find instances of the active aneurism of the left ventricle in Lancisi, De 
rep. mart., p. 137. — Lafaye, in the Mem. de Paris, hist., p. 29.— Corvisart, Journ. de 
tried, vol. xi. p. 257. — We find cases of the passive aneurism of the right ventricle 
only in Fleury, Bull, de VEc. de med., 1807, p. 124.— Morgagni, Epist. anat., m. 
18 to 6. 

(2) We find one case in Corvisart, p. 99. 

(3) Different cases which prove this proposition, both in respect to the simple 
thickening of the parietes, and also to passive aneurism, are mentioned in Vetter, 
loc. cit., p. 99.— Burns.— Morgagni, Ep. anat., m. 18 to 2, 23, 30 ep. 53 to 9.— Corvi- 
sart, p. 61, 87.— Testa, loc. cit., vol. iii. ch. xvi. a. 7, 8, p. 361-367. 

(4) Laennec relates several cases of this abnormal arrangement (Dc V auscultation 
mediate, vol. ii. p. 344) which he terms globular excrescences of the heart, and which 
he compares to the excrescences of the valves. Meckel's mode of explaining them 
cannot be maintained. Bertin (loc. cit., p. 444) not only admits with Corvisart, 
Testa, Burns, Creysig, and Laennec, that polypi, or raiher fibrinous concretions, may 
form, during life, in the heart, as in all other portions of the sanguineous system; 
but he also adopts Kreysig's theory, and regards them as resulting from an effusion, 
which occurs after inflammation of the inner membrane of the heart. These concre- 
tions are most generally free from all adhesions, at least organic ; but sometimes 
also they are perfectly organized, and have numerous vessels injected in bright red 
or black. This important fact, of which Bouillaud has published two remarkable 
instances (Obs. ct cons. nouv. sur Vobliter des veines, in the Arch. gen. dc mcd., voi. v. 



216 DESCBITPTIVE ANATOMi'. 

1st. The form of the heart is more rounded ; this is sometimes met 
with alone, but is usually attended with several other anomalies already 
mentioned, or which remain to be described, as prolapsus, perpendicular 

position, &c. ... 

2d. The deep fissure of the summit of the heart, to which our 
remarks on the preceding anomaly apply. 

The accidental anomalies in the external formation are principally 
the solutions of continuity, which must not be confounded with those 
which are congenital, for the latter implicate the inner form, and they 
consist essentially in anomalies of the connection of the two portions of 
the heart. 

Solutions in continuity of the heart are fissures or wounds. 

Fissures(l) occur most generally after those pathological changes 
which supervene in the substance of the heart itself, or in the arterial 
trunks. They less commonly depend on external injuries, which do 
not directly affect the substance of the heart, but act either on the 
parietes of the thoracic cavity, or on the organs within it. 

1st. The changes in the substance of the heart giving rise fissures, 
are produced principally by inflammation, ulceration, and gangrene,(2) 
which soften this substance, (3) and gradually destroy it in one or more 
parts, so that there is finally a solution of continuity during the systole 
or the diastole. One can imagine that this species of fissures is equally 
frequent in all parts of the heart. 

2d. Those on the contrary which depend on morbid changes super- 
vening in the arterial trunks occur in some points more frequently than 
in others, and are probably more common in one sex than in the other. 

E. 95, and 101), throws great light on the theory of the formation of polypi of the 
eart, inasmuch as we can no longer doubt that their organization takes place in 
the same manner as that of the false membranes, and depends en the same cause. 

F. T. 

(1) Bland, Me.rn.oirc sur le dechirement sinile du occur, in the Bibliothcque medi- 
cate, vol. lxviii. p. 364. — Rostan, Memoircs sur les ruptures du occur, in the Nouveau 
journal dc medicine, vol. viii. p. 265. — A. J. L. Bayle, Observation de rupture die 
occur, in the Revue medicate, vol. iii. p. 96. — Carrier, Observation sur une double 
rupture des parois du vcntriculc gauche du occur, in the Journ. univ. des so. modi* 
cates, vol. xxxv. p. 358. 

(2) Although, strictly speaking, gangrene of the heart is not impossible, it is at 
least so rare that those observers in whom the fullest confidence can be placed have 
not seen it. Thus Corvisart does not hesitate to say that no well authenticated case 
of it exists. Most of the fact3 which have been reported, being stated in a faithless 
manner, should be received only after strict examination and admitted with distrust. 
Such is the very wise opinion of Bertin (Des malad. du cceur, p. 408), who thinks 
that these facts should be considered as acute softenings of the heart rather than real 
gangrenous affections. F. T. 

(3) Laennec first called the attention of pathologists to softening of the heart, of 
which he admits two species, one where the substance of the organ is more deeply 
colored, and the other where it is discolored, or rather has a whitish or yellowish 
tinge (De I' auscultation, vol. ii. p. 186). He asserts that he has found this softening 
in all cases of fevers called essential, when he has attended to them. He does not 
however consider this as a character of inflammation. Bertin thinks it is caused by 
inflammation of the heart, which is acute when it is of a deep red or even brownish, 
and dironic, when the muscular tissue of the organ is discolored and becomes pale- 
or yellowish. p. -f . 



ANGEIOLOGY. 217 

Thus the part of the heart most frequently ruptured is the left ventricle, 
and this accident is more common in the male than in the female, be- 
cause the ossification of the valves and the contraction of the arterial 
orifice, which is a consequence of it, are observed in the left more fre- 
quently than in the right, and in the male oftener than in the female. 
When this occurs, the substance of the heart is thinner less frequently 
than it is thickened and hardened. 

The normal difference between the right and left portions of the heart 
also accounts for the greater frequency of the fissures on the left side, 
since the right side is less tense and more extensive than the other. 

The normal arrangement of the heart explains also why fissures 
occur in one part of the ventricles rather than in another. 

This point is commonly the place where the arterial trunk unites to 
the ventricle,(l) because there is no continuity in this place between 
the fibres of the heart and those of the arteries. 

The place where fissures occur most frequently, next to this, is the 
apex of the heart, as there the substance of the organ is thinnest. 

Contusions of the chest or the forcible penetration of foreign bodies, 
as of musket-balls, also tear the heart, even when the parts surrounding 
this viscus are uninjured. 

Besides these fissures, which are visible externally and which 
pass through the heart entirely, there are others which are much 
less frequent, and where either the tendons of the venous valves or the 
fleshy pillars are detached from their points of insertion. The latter 
almost always result from violent efforts or emotions. (2) 

Wounds of the heart are or are not attended with the presence of 
the wounding body. In both cases they pass through all the substance 
of the organ or affect only its surface. Wounds attended with the 
presence of the foreign body are seen principally after musket-wounds, 
when the ball, not having power enough to pass through the heart, 
remains within it or probably insinuates itself by degrees, the wound 
cicatrizing behind it as it advances. In both these cases the individual 
has sometimes survived so severe an injury, but this is rare. (3) 

(1) This assertion is not correct. Ruptures of the heart occur always, or most 
generally, toward the apex and the anterior part, that is, in the thinnest part. In 
this respect, Rostan has observed that the disproportion of the diameter is such, that 
often, when the diameter of the upper part of the ventricle is sixteen or eighteen 
lines, which he asserts is the greatest development which it can attain, the apex is 
only two lines thick. Bayle has mentioned, that of nineteen instances of rupture of 
the heart, fourteen existed in the left ventricle, principally its anterior face near the 
apex, three in the right ventricle, one in the apex, and the other in the interventricular 
septum. In most of the cadavers the heart was remarkably soft, and in some cases a 
brownish color was observed around the perforation. These two circumstances sup- 
port Bertin's opinion, who (Des maladies du occur) thinks that the preceding erosive 
inflammation plays an important part in these perforations, as in those of the 
stomach and intestines. J\ T. 

(2) Corvisart, loc. cit., p. 256, De la rupture partielle du cceur. 

(3) We find an instance of the first case in the Diet, des sc. mid. vol. iv. p. 217, 
and one of the second in Penada, Saggi sc. diPadova. vol. iii. part 2, p. 59. 

Vol. IT .28 



21g DESCRIPTIVE ANATOM* 

Penetrating, cutting, or pricking wounds are always and almost im- 
mediately mortal.( I ) In order to conceive of a contrary case we must 
admit that the wounding instrument penetrates gradually.! 2) 

<S 1325 Most of the deviations in form in the inner parts of the heart 
are congenital. They comprise, 1st, those which cause no derange- 
ment except in the circulation of the blood ; 2d, those which derange 
the formation of the blood. . 

§ 1326. The deviations of form in the first class consist principally in 
the abnormal arrangement of the several orifices of the heart. 

Among these are : 

1st. The abnormal narrowness of the venous orifices of the ve/ntri- 
cles.{'S) This anomaly occurs most frequently on the left side, and is not 
rare. The mitral valve is then always thickened, more or less hardened, 
and often ossified. It is very doubtful if this anomaly ever be congeni- 
tal. At least it is not so generally. 

2d. The abnormal narrowness of the arterial orifices of the ventricles. 
This congenital aberration occurs most frequently on the right side,, 
and almost always results from a contraction, often also from an ad- 
hesion of the valves. 

(1 ) Wounds of the heart are generally mortal after a few moments, or at most some 
hours. Some wounded persons have been known to survive one or five, seven, thir- 
teen, seventeen, and twenty days, after penetrating wounds. See the surgical 
part of the article Occur, by Begin, in the Diction, abrege des sc. medic, vol. iv. p. 493. 

r. i . 

(2) Although it did not form apart of our author's plan to speak of the alterations 
in the texture of the heart, we think it necessary to say a word upon its hardening, 
the theory of which appears to be intimately connected with that of its hypertrophy, 
its polypi, and its softening, that is with its irritation more or less approaching to 
the degree usually considered as inflammation. General hardening of the heart nas 
not yet been noticed ; but it may be more or less extensive and sometimes invade an 
entire half of the heart. It is often confined to the internal or external face, where 
it is presented under the form of incrustations. The fleshy columns and the septum 
may also be the exclusive seat of it. It presents several degrees. Simple hypertrophy 
is tne first and ossification the last. There are different shades between these two 
extremes ; sometimes the substance of the heart, of a bright red color and almost 
healthy in appearance, resembles in hardness a fibro-cartilage, and resists or grates 
when cut : sometimes it presents a cartilaginous density and solidity : again it is 
still harder and sounds like horn, as Corvisart says ; sometimes it resembles earth 
or sand (Bertin, Des mal. du cceur, p. 401). Ossifications of the heart are not rare in 
man. Meckel has collected several instances in his Dissertatio de cordis conditioni- 
bus abnormibus, Halle, 1802, and in his Manual of Pathological Anatomy. It is cu- 
rious that in many animals, especially in the ruminantia, there is very often a bone 
in the heart. This has long been known in regard to the ox and the stag. See on 
this subject Keuchen, Diss, de ossiculis e cordibus animalium, Groningen, 1772. — 
Jaeger, Veber des Vorkommcn eines Knochen im Herze des Hirsches ; in the Dcut- 
sches Archivfur die Physiologie, vol. v. p. 113.— F. S. Leuckart, Bemcrkungen uber 
den Herzknochen des Hirsches ; same journal, vol. vi. p. 136.— We think it worthy 
of mention, however, that Masuyer has found 1,7 of phosphoric acid, 2 of uric acid, 
3 of animal matter, 5,3 of lime, in twelve grains of the ivory substance coming from 
the ossification of the valves of the heart, from its external face at the base of the right 
ventricle, and from the aorta, and also from the large branches which arise from it 
(Journal de la societe des sciences, agriculture, et arts, dc Strasbourg, 1824, No. 3). 
The presence of uric acid in this case is remarkable as an analogy with what is Been 
in arthritic concretions p. T_ 

(3) Abernethy, On a diminution in consequence of disease of the area of the aper- 
i ure, by which the left auru-le of the heart communicates with the ventricle of the same ; 
io the Med. chir. trans, vol. i. p. 27. 



ANGEIOLOGT 219 

3d. The deficiency or adhesion of the valves, especially those of the 
arteries, sometimes occurs, and is not generally congenital but acci- 
dental. The absence of the valves is caused by their destruction by 
suppuration, and their adhesion results from inflammation and ossifi- 
cation. 

4th. Jin excess or deficient^ in the number of the valves, which is 
seen particularly, but j T et seldom, in the pulmonary artery, and much 
less frequently in the aorta. We find four valves more commonly than 
two. 

§ 1327. The essence of the deviations in form of the second division 
is an abnormal communication between the systems of red and black 
blood. They have no influence on the formation of blood, or when they 
possess it, the arrangement is such that the black blood becomes less 
venous or the red blood less arterial. In both cases the abnormal union 
of both the systems of blood may take place in very different parts. 

1st. The abnormal communication of the first kind depends, 

a. On the insertion of one, of several, or of all the pulmonary veins 
in the vena cava superior. We have a case of this land before us. 

b. On the existence of an accessory pulmonary artery, which arises 
from the ascending aorta.(l) 

2d. The abnormal communications of the second kind occur either 
between the auricles, or the ventricles, or in the large vascular trunks. 
Many or all these anomalies are not unfrequently combined in the same 
.subject. (2) 

a. The most simple form is a single heart, consisting of one muscular 
cavity. 

b. Next follows the formation where only one auricle and one ven- 
tricle exist, whence a single vessel, the aorta, arises, from which the 
pulmonary artery branches off, while the pulmonary veins open into 
the auricle, or even, by a formation still more abnormal, into the vena 
cava superior. 

The formation is more perfect when the heart is divided by a septum 
into two halves, and the aorta and the pulmonary artery arise by sepa- 
rate trunks, but the septum is imperfect. 

c. In this case the septum of the ventricles and of the auricles is per- 
forated and the foramen ovale is open, which is the case most fre- 
quently ; or, 

d. Only the septum between the ventricles is perforated, a more un- 
frequent formation ; or, 

e. Only the foramen ovale is open ; this is the most usual. 

(1) We have collected all the known cases of this anomaly, in the De monstrosa 
duplicitate, p. 55, and in Handb. der pathol. Anat., vol. ii. p. 134. 

(2) The different degrees and in general most of the species of this class of ano- 
malies are described in our Handbuck der pathol. Anat., vol. i. p. 422-470, vol. ii. p. 
133 134. — Farre, Pathological researches, Essay 1, On malformations of the human 
heart, London, 1814.— J. C. Hein, De cordis deformationibus qucc sanguinrm rrnosvm 
<~*m arteriosomifceri prrmi'Junf, Gottingen, 1816. 



220 DESCRIPTIVE ANATOMY. 

The septum of the ventricles is perforated generally in on* determi- 
nate place, viz. the base ; so that sometimes the aorta, sometimes but 
more unfrequently the pulmonary artery, arises from both ventricles : 
in the latter case the aorta arises as usual, but forms only an ascending- 
portion, and terminates in the left subclavian artery, and the descending 
aorta comes entirely from the pulmonary artery. 

The interauricular septum is frequently developed imperfectly, that 
is, its formation has not followed the course mentioned above (§ 1305), 
but the pressure of the left auricle can then complete it ; so that the 
passage of the blood from this auricle into the right becomes impossi- 
ble. Sometimes however, but more unfrequently, from the absolute or 
relative smallness or deficiency of the valve of the foramen ovale, this 
opening is so large, that the right and left auricles communicate 
freely. This continuance of the foramen ovale is more unfrequent than 
the perforation of the septum, although its imperfect closure, produced 
in the manner stated above (§ 1305), is an anomaly still more frequent, 
than this. 

The abnormal arrangements of the large vascular trunks, which 
render the hematosis imperfect, are, 

/ The obliteration or the considerable contraction or deficiency of 
the pulmonary artery, states which commonly but not always attend 
one of the anomalies mentioned above. 

g. The continuance of the arterial canal, which seldom occurs alone, 
but is generally attended with one of the anomalies already described 
or which remain to be mentioned. 

h. The existence of a second pulmonary artery, which arises from 
the right ventricle and terminates in the aorta. Finally, 

The transposition of the origins of the arterial or venous trunks, viz. 
i. The origin of the pulmonary artery from the left and of the aorta 
from the right ventricle, while the venous trunks empty themselves in 
their proper places.(l) 

h. The insertion of the veins of the body into the left portion of the 
heart, or into the pulmonary veins, or frequently into the pulmonary 
artery. This occurs in different ways. We have before us a prepa- 
ration where the large coronary vein of the heart, instead of terminating 
in the nght portion, opens into the left auricle of the heart. In another 
case, the vena azygos is divided near the heart into two branches one 
of which goes to the right, the other to the left auricle. Sometimes 
the pulmonary artenes evidently anastomose with the azygos vein. 

The physiological influence and importance of these anomalies are 
not the same. 

f In the first point of view, we may state it as a principle, that the first 
ax arise because the formation of the heart is arrested at an early period 
of development, and because it is a repetition of the formation of the 

j^p^^^iTm^^ a easc of this anomaiy in *» *** " r 



ANGEIOLOGY. 22 1 

heart in some of the lower classes of animals, particularly the crusta- 
ceous animals, the mollusca, and the reptiles. The others are normal 
in no period of life, but belong to the class of anomalies which affect the 
quality of the organs. 

Hence also why the former are more frequent. The influence on 
the hematosis is much more injurious, the greater the mixture of the 
black and red blood : it is very slight either when the abnormal com- 
munication is merely by the small vessels (k), or when the communi- 
cation is interrupted by the arrangement of the parts at the moment 
when it might be injurious : this occurs in most cases where the foramen 
ovale becomes open. The derangement is very great in other cases. 

The effects which result from them are, frequent recurrence of asth- 
ma, extreme weakness of the voluntary muscles, great debility in the 
nervous system, often a defect in nutrition and development, and a blue 
color of the body. Death usually supervenes in the early periods of 
life, although in a few rare cases the patient has lived till the age of 
fourteen. At certain periods, especially during dentition and at the age 
of puberty, the symptoms recur more frequently and with greater vio- 
lence. The cause 'of* these symptoms and the essence of the derange- 
ment is, the mixture of venous with arterial blood and the distribution 
of this mixed blood in the body ; they arise somotimes, as for instance 
when the pulmonary artery is entirely closed or does not exist, or when 
the pulmonary artery arises from the left ventricle and the aorta from 
the right ventricle, because the organs of the body receive pure venous 
blood. 

From the blue color of the skin, which depends upon the venous 
blood not being changed into arterial blood,(l) this disease has been 
termed cyanopalhia (morbus cceruleus, cyarwpathia, cyanosis). (2) 

(1) Bertin has very properly remarked that this explanation cannot be admitted, 
for three reasons : 1st, Tbecause cyanosis did not 1 exist in cases where the right and 
left heart communicated ; 2d, because it did exist in other cases where this commu- 
nication did exist ; 3d, because that if the blue color of the skin was produced by this 
deviation of formation, it ought to exist also in other parts, which is not the case. 
Besides, as Fouquier justly remarks, the skin of the fetus, in which only black blood 
circulates, is not blueish. Bertin thinks then that the blueish color of certain parts, 
in different individuals where the two hearts communicated, depends on the stag- 
nation of the blood in the right cavity and in the venous system, which is in a man- 
ner forged with it ; this explanation seems more rational, inasmuch as this anomaly 
in the formation of the heart is often attended with a contraction of the orifices or of 
the pulmonary arteries. F. T. 

(2) Kwiatkowski, Diss, actiologiam mxrrbi ccerulei amplificans, Wilna, 1816. — Hein, 
Diss, de istis cordis deformationibus qua sanguinem venosum cum artcrioso misccri 
<permittunt, Gottingen, 1816. — J. F. Meckel, Essai sur les vices de conformation da 
cceur qui s'opposent a la formation du sang rouge ; in the Journ. complem. des sc. 
med. vol. iii. p. 224-301. — Gintrac, Observations ct recherches sur la cyanose, cm ma- 
ladieblue, Paris, 1824. — Louis, Observations suivies de quelques considerations sin- 
la communication des cavites droites avec les cavites gauches du cceur ; in the Arch ivs 
ernerales de medecine, vol. iii. p. 325. 485. 



223 BESCRIPTIVE ANATOMY. 

SECTION II. 

ARTERIES OF THE BODY OR OF THE SYSTEM OF THE AORTA 

CHAPTER I. 

GENERAL EXPLANATION OP THE SITUATION OF THE TRUNK. 

§ 1328. The aorta arises most generally and with but few excep- 
tions by one single stem from the upper part of the left ventricle. At 
its origin the fibrous membrane is much thinner than in the rest of its 
extent ; but it is not entirely destitute of this membrane, the thinness 
of which is supplied by the muscular fibres of the heart, which extend 
some lines over the valves of the aorta, and the triangular spaces 
which exist between them. At its base are three sinuses, which cor- 
respond to the valves. It goes to the right, first its right side, and 
then the whole artery passing behind the pulmonary artery, which 
covers its origin : it comes afterwards on the right side of this artery, 
and describes a curve before the vertebral column, which is called its 
arch (arcus aortce). The transverse portion of this arch, the part be- 
tween the right and left sides, is situated opposite the third and fourth 
dorsal vertebrae. 

At the origin of the arch the aorta is entirely inclosed in the pericar- 
dium ; but it gradually leaves this membranous sac ; so that most of 
the arch is entirely loose. We observe on the left the pulmonary artery, 
which proceeds along the lower part of the arch of the aorta, behind it 
the right branch of this artery, on the right the vena cava superior, and 
in front the sternum. 

In old age, the lower and ascending part of the arch of the aorta is 
more or less dilated : it does not form a perfect cylinder ; but it advances 
farther and projects more to the right than in early life. This change 
probably depends on a mechanical cause,— the continual impulse of the 
blood. 

The central part of the arch of the aorta is situated before the lower 
extremity of the trachea, and the curve terminates behind the left branch 
of the pulmonary artery and the bronchia of the same side, in which 
place the direction of the artery changes and proceeds from above down- 
ward. 

The ascending part of the arch is situated on the right of the verte- 
bral column, the transverse portion directly before it and the descending 
portion on the left : the latter is situated in the posterior mediastinum 



ANGEIOLOGY. 223 

The trunk of the aorta remains on the left of the vertebral column 
in all its extent. 

The ascending portion of the aorta in the cavity of the thorax, called 
the thoracic aorta (aorta thoracica), is directly covered on the left by 
the inner wall of the left pleura, on the right by the esophagus, and 
forward first by the left bronchia, then by the posterior part of the peri- 
cardium. 

At the diaphragm the aorta separates from the esophagus behind, 
passes through a special openingin this muscle (hiatus aorticus)(§ 1072), 
comes into the abdomen, ajid is called the abdominal aorta (aorta 
abdominalis). The latter descends as far as the fourth or fifth lumbar 
vertebra, where it divides into two branches. It is attended on the 
right by the vena cava inferior, rests behind on the lumbar vertebrae, 
and is covered both before and on the left by the peritoneum. 

Above and below, it divides in an analogous but not in the same 
manner, since it gives off, 1st, at its two extremities, the vessels which 
go to the extremities ; 2d, and besides, at the upper extremity, the 
carotid arteries ; 3d, at the lower extremity those which supply the 
pelvic viscera with blood. 

The vessels of the thoracic and abdominal viscera, and most of those 
which are distributed to the parietes of the thorax and abdomen, arise 
directly from the part between its two extremities. 

That part of the aorta between its origin from the heart and that of 
the left subclavian artery (§ 1335), is called the ascending aorta (aorta 
ascendens), the remaining, the descending aorta (aorta descendens). 

§ 1329. The aorta rarely varies from this general arrangement. 
Nevertheless it may, in the following modes :(1) 

1st. The slightest aberration is when the aorta goes backward too 
soon, passing immediately on the right bronchia. 

Then it sometimes reaches the left side, gliding behind the esophagus 
and the trachea, as we have observed ;(2) sometimes it remains on the 
right in a greater or less extent of the vertebral column, for instance, to 
the base of the chest. 

This anomaly may be considered as the first degree of the lateral 
inversion of the aorta, in which its arch curves more or less from left to 
right instead of describing its usual curve from right to left. 

The arteries which arise from it are also modified in a similar man- 
ner ; for we sometimes find four trunks ; sometimes an innominata 
trunk exists on the left side and two other trunks on the right. 

2d. The anomaly is greater when the trunk of the aorta tends to 
divide. This deviation of formation presents several degrees. 

(1) O. Bernard, Diss, de arteriarum e corde prodeuntium aberrationibus, Berlin, 
1818. 

(2) This anomaly has been seen also by Abernethy (Phil, trans., 1793, p. 59-63), 
and twice by Caillot (Bullet, de VEc.dc Med., 1807, p. 21-28). 



224 DESCRIPTIVE ANATOMY 

a. Sometimes the aorta is single at its origin ; but, some inches fai 
ther, it divides into two trunks, which pass one before, the other behind, 
the trachea, and afterwards unite to give rise to the descending aorta, 
forming in this manner a ring around the air passage. Hommell has 
described a curious case of this kind. 

b. A greater degree of this deviation of formation exists as in the 
case reported by Malacarne.( 1 ) In fact the aorta is single at its origin ; 
but from this point even, its increased size, its oval form, and its five 
valves, indicate a division which occurs almost immediately. The 
two branches on the right and on th* left give off, first the sub- 
clavian, then the external carotid, and finally the internal carotid, 
artery ; they remain distinct from each other for about four inches, and 
then they unite to form the descending aorta. 

This division of the largest artery of the body is curious in this 
respect, that it is evidently a repetition of the formation of reptiles, a 
class of animals in the different orders of which these anomalies con- 
stitute the normal state. It leads also to the third kind of anomaly. 

3d. In this species of anomaly there is no arch. The aorta divides 
at its origin into two trunks, one right and ascending, which produces 
the subclavian and carotid arteries; the other descends and is the 
pectoral and abdominal aorta. (2) 

§ 1330. The aorta presents anomalies not only at its origin, but 
also in the rest of its course. Thus, the lower extremity of the arch 
is sometimes very much contracted(3) or entirely closed(4) in a slight 
extent ; and although the artery does not divide in this place into two 
large trunks, the circulation however continues by collateral vessels, 
which are very much enlarged. 

Similar anomalies are observed also, but less frequently, in the lower 
part of the aorta. Thus sometimes the artery bifurcates higher than 
usual, to give rise to the primitive iliac arteries, which, before they 
divide into two large trunks, communicate by a transverse branch.(5) 



CHAPTER II. 

ARCH OF THE AORTA. 

§ 1331. From the arch of the aorta, or from the ascending aorta, 
arise first, the coronary arteries of the heart ; next, at a certain distance 
from them, the arteries of the upper extremities and of the head, which 
come from its upper and transverse part. 

(1) Osscrv. di chirurgia, vol. ii. p. 119, tab. i. f. 1, 2.—Auctuarium obs. et. icon, ad 
osteol. Padua, 1801, tab. iii. 

(2) Abhaiidlungen dcr Joseph. Akadcmic, p. 1. tab. vi. 

(3) Paris, inDesault, Journ. de. chir., vol. ii. p. 107, 110. 

(4) Steidele, Sammlung chirurgischer Bcobachtungen, vol. ii. p. 114, 116. — Gra- 
ham, in the Med. chir. trans., vol. v. no. xx.— Cooper, in Farre, lor. cit., p. 14. 

(5) Petsche, Syllog. obs. anat. select., § 77. 



ANGEIOLO^i. 225 



ARTICLE FIRST. 

I. CORONARY ARTERIES OF THE HEART. 

§ 1332. The coronary arteries (.,2. coronarice, cardiacw) arise directly 
above the origin of the aortn, and normally above the upper edge of 
the semilunar valves, so that their orifices, which correspond to the 
central part of these valves, are not closed when these valves are 
pressed against the parietes of the aorta. There are usually two, and 
not unfrequently three ; the third, which is generally smaller than the 
others, then arises, not above a special valve, but above and very 
near one of those to which the other two correspond. We once have 
found four coronary arteries, of which the two supernumerary arte- 
ries were much smaller than the others, and only branches prematurely 
detached from them. 

A single coronary artery is much more rare. We have seen this 
anomaly which however is indicated by the less distance between the 
origins of the two arteries in some subjects, or in the extreme smallness 
of one of these vessels, the branches of which are entirely replaced by 
those of the other.(l) The existence of one coronary artery is curious, 
as it establishes a relation with the normal formation of the elephant. 

But however this may be, each ventricle has a coronary artery which 
almost exactly corresponds to it. 

§ 1333. The right, upper, or anterior coronary artery (Jl. coronaria 
anterior, s. inferior, s. dextra) is generally but a very little larger and 
rarely smaller than the left. It arises from the anterior part of the 
aorta, above the anterior valve, passes under the pulmonary artery, 
between the upper part of the right ventricle and the right auricle, 
being covered by the latter, goes forward to the right, and downward 
in the groove at the base of the heart, turns around the pulmonary 
auricle, and thus arrives at the lower face of the heart, and terminates 
in the inferior groove of its septum. 

In its course it gives off at right angles, both on the right and left 
sides, several branches, which are often very much curved. 

The right branches are smaller and are distributed to the right 
auricle ; the left, which are larger, go to the right ventricle, and 
descend longitudinally on its surface to its apex. 

The longest of these descends in the inferior groove of the septum, 
where it anastomoses by several branches with the left coronary 
artery. 

Other ramifications always exist, which are smaller, and are dis- 
tributed on the anterior part of the left ventricle, and also commu- 

(1) Barclay (loc. cit., p. 6) has seen the right coronary artery so small that it did 
not extend to the left as far as the septum, and was replaced on thi3 side by the 
transverse branch of the left coronary artery. 

Vol. IT. 29 



•J26 DESCRIJTHTE ANATOMY. 

nicate with those of the left coronary artery on the flat side of the 
heart. 

This artery belongs principally to the right half of the heart. 

§ 1334. The left, upper, or posterior coronary artery {Ji. coronaria 
sinistra, s. superior, s. posterior) is generally smaller than the pi 
ing, and arises between the left auricle and the posterior side of the 
pulmonary artery, almost always above the left sigmoid valve. It 
descends on the left, between the auricle and the pulmonary artery, 
and having attained the groove at the base of the heart divides into 
two or three larger branches. 

Of these one, which is anterior and longitudinal, soon separates into 
several considerable branches, and descends along the upper groove 
of the septum to the apex of the heart. In its whole course it gives 
off branches which anastomose with those of the right coronary artery 
on the upper face of the right ventricle. Some of the large branches 
which come from it are distributed on the upper face of the left ven- 
tricle. 

The second branch, which is transverse, goes backward in the 
groove at the base of the heart, below the left auricle, and gives several 
branches, which go to the upper face of the left ventricle. The largest 
descend along the smooth posterior edge of the heart, some on its upper 
and others on its lower face. 

Finally, the left coronary artery terminates by several small branches, 
which disappear on the lower face of the left ventricle. 

These ramifications, like the preceding, anastomose with the other 
branches of the left coronary artery and with those of the right which 
meet them. 



ARTICLE SECOND. 

OF THE ARRANGEMENT OF THE LARGE TRUNKS WHICH ARISE 
FROM THE UPPER PART OF THE ARCH OF THE AORTA. 

§ 1335. From the upper transverse part of the arch of the aorla 
arise the trunks which carry the blood to the head, the neck, the upper 
and anterior part of the chest, the upper extremities, and partly to the 
pericardium, the mammary glands, and the lungs. 

There are usually three trunks, which arise a few lines distant from 
each other, the common trunk, or the innominata artery {truncus com- 
munis, s. innominatus), from whence arise the right subclavian and the 
right carotid arteries, the left subclavian and the left carotid arteries. The 
innominata artery is situated farther to the right and in front of the 
others ; the left carotid artery in the centre and a little farther back ; 
finally, the left subclavian artery most on the left and farther back 
than the other two. 



After birth, the origin of the left subclavian artery sometimes but not 
always occupies the highest part of the arch of the aorta, while in the 
fetus it arises the lowest. So likewise in the fetus the innominata artery 
occupies the highest part of the arch of the aorta.(l) The innominata 
artery, in ascending from left to right, is situated in front of the trachea. 
It is separated from the vertebral column by the longus colli muscle, 
and from the sternum by the stemo-thyroideus and by the left subcla- 
vian artery at its side. It is most generally an inch long, rarely longer : 
sometimes however it is two inches long, and then the trunk reaches 
the inferior edge of the thyroid gland. 

The left carotid artery arises, more perpendicularly on the left side 
along the trachea. 

The right carotid and right subclavian arteries are shorter than the 
synonymous arteries on the left side. 

The diameter of the vessels of the two sides is the same, or at least 
those of the right side are but little larger than those on the left. 

The innominata artery usually arises at the side of the left carotid 
artery ; the left subclavian artery arises from the aorta, at some dis- 
tance from the latter ; but the interval between them is not always 
very great. 

The abovementioned arrangement is the most common ; we may 
then consider it as the normal arrangement. Frequently however, at 
least once in eight times, (2) the number of the trunks given off from 
the arch of the aorta varies. This number may be increased or dimi- 
nished. In the former case, vessels, which are generally branches, arise 
directly from the arch of the aorta ; in the latter case, one of the three 
primitive trunks or frequently all of them are blended with each other 
and form but one.(3) 

(1) Sabatier first pointed out this difference. (See his Afcmoire sur les change- 
mens qui arrivent aux organes de la circulation du foetus lorsqu'il a commence a rc- 
spircr ; in the Mem de Vlnstitut ; sc. phys. et math., vol. iii. p. 342.) We are how- 
ever satisfied, by numerous observations, that it is not by any means constant. Thus 
most anatomists have disregarded it. Portal even asserts thetontrary (loc. ctfc, p. 
185), for he states "that the trunk of the left subclavian artery opens into the aorta 
a little lower than the other two trunks." 

(2) Bichat's assertion that "the arrangement of these arteries is but slightly subject 
to variation" is incorrect. Hallcr makes almost the same statement, and with no more 
foundation. Nor is Barclay more correct in asserting that " the cases are rare where 
a vertebral artery, a thyroid, a thymic, a pericardiac, or an internal mammary 
arise from the arch." Only the anomalies of the internal mammary artery are rare. 

(3) Besides all insulated descriptions of the anomalies in the trunks which arise 
from the arch of the aorta, we may consult the following works, in which this question 
has been specially examined, and in a more or less general relation : — Bcehmcr, Dc 
quatuor et quinque ramis ex arcu aortce provenientibus, Halle, 1741. — Neubauer, Dc- 
scriptio anatomica arterice innominatce et thyroidece imce, Jena, 1772. — Huber, De 
arcus aortce ramis ; in the Act. Helvet., vol. viii. p. 68102. — Walter, Sur les maladies 
du cceur ; in the Nouv. Mem. de Berlin, 1785, p. 57. — Malacarne, Oss. sopra alcunc 
arterie del corpo umano nello stato preternaturale e nello stato morboso ; in the Os- 
scrvaz. di chirurgia, ii. Turin, 1784, p. 119. — Ryan, De quarumd. arteriarum in 
corp. hum. dislributione, Edinburgh. 1R10. — Koberwein, De rasorum decursu flk- 
vormi. Wittenberg. 1P10. 



22Jb DESCRIPTIVE A.N.VTlOi.. 

§1336. Tlic number- of the primitive trunks is increased mor< 

quently than diminished. Most frequently we find four trunks, our 
more than the normal number. 

This anomaly does not alwa} r s occur in the same manner. 

§ 1337. Our observations on this subject are principally as follow . 

1st. Most generally the left vertebral artery, which is normally a 
branch of the subclavian artery, arises directly from the aorta. This 
is the most common anomaly. (1). Notwithstanding the abnormal 
origin of the left vertebral artery from the arch of the aorta, the number 
of trunks is not increased ; because at the same time the left carotid 
artery passes to the right and becomes a branch of the innominata 
artery. This arrangement is remarkable, for it announces an effort 
tending to bring the anomaly to the normal type of formation. 

2d. After this variety, the most common is that where the inferior 
thyroid arterjr, or a portion of it, which is always the thyroid portion, 
arises from the arch of :he aorta. This anomaly occurs on the right 
side more frequently than on the left, and this vessel then arises, like 
the left vertebral artery, between the innominata and the left carotid 
artery. 

Besides these, we sometimes see coming from the arch of the aorta, 
in no determinate place, and most generally a little before the large 
trunks, and not on the same line with them, 

3d. A thymic artery {Ji. thymica), or 

4th. An internal mammary artery (A. mammaria interna). 

Less frequently, four trunks arise from the aorta, when the right 
subclavian artery comes directly from the arch of the aorta. We here 
find many differences. 

5th. The right subclavian artery arises farthest to the right, or 

(1) Bichat is also incorrect in saying that ihis anomaly is more rare than an increase 
in the number of the trunks of the aorta by a most inferior thyroid artery. Saba- 
ticr goes even farther, for he does not mention it at all, although he states several 
other anomalies which increase the primitive trunks of the arch of the aorta (Anat., 
vol. iii. p. 7). Portal also is silent in regard to it and only mentions the division of 
the trunk of the innominata among the causes which increase the number of the 
arteries given off directly by the arch of the aorta (Anat. mcd., vol. iii. p. 155). In 
fact, in another place he states that the left vertebral artery arises directly from the 
aorta; but he adds, contrary to what is the fact, that this arrangement is very rare. 
Monro docs not mention it when treating of the anomalies of the trunks which arise 
from the arch of the aorta ( Outlines, vol. iii. p. 276, 278), although he speaks of them 
when treating of the varieties of the subclavian artery (he. cit., p. 301). Scemmer- 
ring, on the contrary, very properly seems to regard it as the most frequent anomaly, 
and mentions it as the first case where four arteries arise from the arch of the aorta. 
Boyer (Tr. d'anat., vol. iii. p. 41) asserts, that the origins of the left vertebral and of 
a most inferior thyroid artery are equally common and just as frequent. It has 
been asserted that this anomaly was more rare in the south of Germany than that 
of the origin of the right subclavian artery directly from the aorta. We are satisfied 
from observation that this is incorrect ; and wc cannot agree to it, because other 
anatomists of great authority, particularly Haller (Jc. an.J'asc. vi. p. 1), Neubaucr 
(loc. cit., p. 287), Scemmerring and Boyer (lot: cit., p. 25), assert exactly the contrary, 
and itis refuted by comparing the number of known cases which memjon the different 
anomalies in the trunks of the arch of thp aortn. 



ANGEIOLOGY. 229 

6th. This, which is much more common, arises farthest to the left, 
below the left subclavian artery. 

Between these two formations there are several degrees ; for the right 
subclavian artery arises 

7th. Between the right and left carotid arteries ; sometimes 

8th. Between the left carotid and the left subclavian artery. 

Of these five anomalies, in all of which the right subclavian artery 
is insulated from the right carotid, the second is undoubtedly the most 
frequent. When it exists, the right subclavian artery generally passes 
between the esophagus and the trachea, seldom before the latter, and 
goes to the right arm. 

9th. This division of the innominata artery is sometimes attended 
with the transposition of both carotid arteries ; so that 

10th. First the left, then the right carotid artery, next the left sub- 
clavian artery, and finally the right subclavian artery arise ; or 

1 1 th. Both of the carotid arteries and the right subclavian artery 
arise in their normal places, but the origin of the left subclavian artety 
is farther to the right. 

But the separation of the right subclavian artery from the right 
carotid does not necessarily increase the number of the trunks ; for 
then both carotids are usually blended into one trunk, an arrangement 
to which may be applied our remarks upon the analogous union oc- 
curring when the vertebral artery arises directly from the arch of the 
aorta. 

§' 1338. More rarely five trunks arise directly from the arch of the 
aorta. When this occurs, 

12th. The aorta gives off, besides the usual three trunks, the left 
vertebral artery, and the right internal mammary artery ; (1) or, 

13th. It gives off a right inferior thyroid artery, (2) or, the innomi- 
nata artery divides into the right subclavian and right carotid artery, 
the former arising farthest on the right ; and besides, 

14th. The left vertebral artery, (3) or the right inferior thyroid 
artery, (4) arises directly from the aorta ; or, 

15th. The right subclavian artery arises below the left, at the same 
time that the trunk of the innominata is divided into the subclavian and 
carotid arteries, and that the left vertebral artery arises directly from 
it. (5) Finally, sometimes, although seldom, instead of three trunks, 

16th. We have six. The aorta then gives origin to the right sub- 
clavian and carotid arteries, separately; the right vertebral artery 
arises between them, and the left vertebral artery springs directly from 

(1) Boehmer, loc. cil. ; in Haller, Coll. diss., vol. ii. p. 453. 
(2i We have seen this anomaly twice. 

(3) Loder, Nonnull. arter. variet., Jena, 1781. 

(4) Petsche, in Haller, Coll. diss., vol. vi. § 44. 

(5) Koberwein, Dc dccursu vasorum abnorm., Wittenberg, 1813. 



230 DESCRIPTIVE AN.VJOMY 

the arch of the aorta, between the left carotid and subclavia 
teries. (1) 

§ 1339. The number of the trunks is diminished in several modes. 

17th. The left carotid artery is a branch of the innominata, or, 

18th. It arises by a common trunk with the subclavian artery of the 
same side ; or, 

19th. The first trunk divides into the two carotid arteries, the se- 
cond into the two subclavian arteries ; or, 

20th. The right trunk is the right subclavian artery, the left is the 
common trunk of the left subclavian and the two carotid arteries. 

The last anomalies are as rare, as the first is common. Our ob- 
servations have proved that the latter and the distinct origin of tho 
left vertebral artery, are the most common. 

§ 1340. Sometimes, when the number of the trunks is neither in- 
creased nor diminished, their arrangement varies from the normal state. 
Abnormal unions and divisions then exist, of which the principal arc 

21st. The innominata artery is divided, but the two carotids arise by 
a common trunk, which is implanted in the arch of the aorta, between 
the two subclavian arteries. 

22d. The innominata artery is divided, on the right side into the sub- 
clavian and carotid arteries ; but on the left side, both of these arteriei 
arise by a common trunk. The preceding formation leads then to a 
total inversion of the origin of the vessels. 

23d. The innominata artery is divided, but we find a common trunk 
for both carotid arteries, and 2d, one for the left, and 3d,, one for the 
right subclavian artery, which then arises farther from the left side 
than usual, most generally below the left, and goes to the right upper 
extremity, passing before or behind the trachea, and most commonly the 
esophagus. 

24th. The innominata artery also gives off, besides its usual 
branches, the left carotid artery ; but the left vertebral artery then 
arises directly from the arch of the aorta, between the other two 
trunks. 

§ 1341 . Finally, the least possible anomaly is where only the relative 
situations of the larger trunks which come from the arch of the aorta 
are changed : they are, 

1st. The trunks arise uncommonly near each other. The left ca- 
rotid artery then most generally approaches the innominata. This 
anomaly makes the transition to the union of the two carotids into one. 
Again, but more rarely, the left carotid artery separates from the inno- 
minata, while the left subclavian artery approaches it. This anomaly 
leads to another case which is rarer, where the left earotid and left 
subclavian arteries arise by a common trunk. 

(1) This anomaly has been seen by F. Muller, formerlv demonstrator at Copen- 
hagen, whocommunicated it to mc 



ANGEIOLOGV 231 

Sometimes also the three trunks are so near each other, that they 
in fact arise from the same surface, or form but one stem. This ano- 
maly evidently makes the transition to that where the aorta divides, 
directly after its origin, into an ascending and a descending trunk. 

2d. The distance between the origin of the trunks is sometimes un- 
usually great. Thus we have found in a child two years old, the left 
carotid artery nearly an inch distant from the innominata ; the left 
subclavian artery was also nearly an inch from the left carotid ; the 
arch of the aorta was extremely sharp, and the left carotid artery arose 
from the angle formed by the union of the right and left portions. 



ARTICLE THIRD. 

PRIMITIVE CAROTID ARTERY. 

§ 1342. The primitive or common carotid artery (Carotis primitive, 
s. cephalica) ascends along the trachea, which generally separates that 
of the right and left sides. It usually extends to the upper extremity 
of the larynx, where it bifurcates, at some distance from the angle of 
the lower jaw, and seldom behind it. It is situated very superficially, 
especially its central part, so that it is most easily found there. It is 
covered before by the sterno-cleido-mastoideus, the sterno-hyoideus and 
the omo-hyoideus muscles ; the internal jugular vein and the pneu- 
mogastric nerve are on the outside, and a little in front of it ; the latter 
is situated between the two vessels ; inside are the trachea, the larynx, 
the thyroid gland, and also the esophagus ; behind it is the cervical 
portion of the great sympathetic nerve, the longus colli and rectus 
capitis major muscles, and the inferior thyroid artery, which separate it 
from the vertebral column. The inferior thyroid artery seldom passes 
before it. The primitive carotids are generally situated on the two 
sides of the trachea, the right a little more forward than the left ; but 
sometimes, particularly at their lower parts, they are placed somewhat 
before this canal. The right carotid artery assumes this arrangement, 
especially when the innominata arises unusually far on the left, and 
the left when it arises from this trunk. In both cases the arteries cross 
the interior face of the trachea. These anomalies should be known, as 
they endanger the carotid arteries in the operation of tracheotomy. 

The primitive carotid is inclosed with the internal jugular vein and 
the pneumogastric nerve, in a very firm cellular sheath. 

§ 1343. From the primitive carotid artery arise only small and in- 
constant vessels, which go to the surrounding parts, but sometimes, 
and not unfrequently, it gives off, especially on the right side, the su- 
perior or the inferior thyroid artery, either wholly or partially ; the lat- 
ter is more common. The origin of the inferior is, in this case, towards 
the lower part ; that of the upper, near the upper end of the artery. 



232 DESCRIPTIVE ANATOMl 

§ 1344. The common carotid artery divides, generally as high as 
the upper edge of the thyroid cartilage, into two branches, one of 
which, the internal carotid, supplies the brain and the eye, while the 
other, the external carotid, belongs to the upper part of the neck, the 
skull and the face. It sometimes bifurcates much higher up, opposite 
the upper extremity of the styloid process, but not till it has given off 
the larger of the longer branches of the external carotid.(l) This 
arrangement is very analagous to that where the primitive trunk does 
not divide into two large branches, but having given off the branches 
of the external carotid artery.(2) This anomaly consists evidently in 
the premature division of the trunk, while its branches are given off too 
soon. In some few cases the division extends much farther, and 
attains even the trunk of the primitive carotid. This trunk then begins 
to divide very soon, and it sometimes bifurcates, opposite the sixth 
cervical vertebra, but the two branches remain connected with each 
other.(3) 

The distance between the place of bifurcation and the thyroid carti- 
lage is the"same at all periods of life: (4) but the distance between 
the bifurcation and the angle of the lower jaw is much greater in the child 
than in the adult, on account of the development of the teeth, so that 
during early life the two large inferior branches are loose for some dis- 
tance. 

These two branches ascend almost perpendicularly. Below they 
are situated directly at the side of each other. The internal is at first 
more superficial than the external carotid, but it afterwards becomes 
deeper. Their proportional volume is not always the same. The dif- 
ferences depend partly on the age, partly on the distribution of the ex- 
ternal carotid artery. 

In the first respect, the internal carotid artery is always larger than 
the external in infancy, on account of the size of the brain : in the se- 
cond, the external is larger than the internal carotid in the adult, when 
it gives off the superior thyroid artery, and smaller than it, on the 
contrary, when the latter comes from the prmitive carotid. 

I. EXTERNAL CAROTID ARTERY 

§ 1345. The external carotid artery (Carotis externa, s. facialis, 8. 
A. pericephalica) ascends under the posterior belly of the digastricus 
muscle of the lower jaw, is situated between the ear and the ascending 
branch of the lower jaw, where it is entirely covered by the parotid 
gland, and divides at the neck of the lower jaw into a superficial 
branch, which is the temporal artery, (A. temporalis) and a deeper seated 

(1) Burns, Surgical anatomy, Edinburgh, 1811, p. 95, %. 

(2) Idem, ibid., p. 95. 

(3) Idem, ibid., same page.— We regret that the author does not say whether tlio 
anomaly existed on the two sides or only on one side, (perhaps the left 7) 

' 1) Idem, ibid., p. 379. 



ANGEIOLOGY. 233 

branch, the internal maxillary artery. (A. maxillaris interna.) But it 
always gives off large branches, before it bifurcates. These branches 
generally detach themselves gradually, one after another. Sometimes, 
however, the external carotid artery forms a short trunk, which divides 
directly above the bifurcation of the primitive carotid into the large in- 
ferior branches, and the broad continuation of the trunk. 

§ 1346. Before bifurcating, the external carotid artery gives off 
branches principally in three directions : forward, backward, and in* 
ward. 

A. ANTERIOR BRANCHES. 

§ 1347. The anterior branches are the superior thyroid artery, the 
Ungual artery, and the facial artery. 

1. SUPERIOR THYROID ARTERY. 

§ 1348. The superior thyroid artery (A. thyroidea superior) is the 
lowest branch of the external carotid artery. Its origin varies : it gene^ 
erally arises some lines above the bifurcation of 'the primitive carotid ; 
but it not unfrequently detaches itself at the bifurcation, or below, and 
even from the trunk of the primitive carotid ; sometimes an inch below 
its bifurcation. 

Its size also varies, and it is in the inverse ratio of that of the inferior 
thyroid artery. When the latter is entirely deficient, the superior is 
much larger than usual ; it is on the contrary very small, when the 
inferior thyroid artery is very large, or when the lowest thyroid artery 
exists. 

Sometimes, but unfrequently, it arises by a common trunk, with the 
lingual artery, and in some subjects this trunk comes from the primi- 
tive carotid. 

On the other hand, we not unfrequently find the superior thyroid 
artery double, because the branches which it generally gives off are 
detached lower than usual. The arrangement and size of the left and 
right thyroid arteries vary ; sometimes one of them is deficient, while 
the other is very large. 

§ 1349. When the artery does not arise much lower than usual, 
nor from the primitive carotid, it always descends inward and forward, 
being at first slightly concave above, and very tortuous. It sometimes 
gives off a large branch immediately after arising, which detaches 
itself from its posterior and inferior part, and goes to the sterno-cleido. 
mastoideus muscle. It then soon divides into an upper and a lower 
branch. Sometimes it bifurcates near or even at its origin. 

The upper or laryngeal branch (ramus laryngozus) arises from the 
external carotid artery, according to our observations, once in eight 
times. It goes downward, forward and inward, on the thyroid carti- 
lage, and frequently gives branches to the omo-hyoideus,the sterno-hyoi- 
deus', the sterno-thvroideus, the hyo-thyroideus and the crico-thyroideus 

Vol, II 30 



234 DESCRIPTIVE ANATOMY. 

muscles, which come sometimes from the lower branch, or directly from 
the external carotid artery : furnishes a large anastomotic vessel which 
goes across the cricoid cartilage, and unites with the branch given off by 
the synonymous artery opposite ; finally it penetrates within the larynx, 
passing generally between the hyoid bone and the thyroid cartilage, 
sometimes, but more rarely, near the upper edge of the latter, by an 
opening which exists there, or even between the cricoid and the thyroid 
cartilages.(l) Having arrived at this organ, it distributes itself upon 
its internal membrane, and also to its nmscles, anastomoses very fre- 
quently with the synonymous artery of the opposite side, and even sends 
ramuscules outside of the larynx, which communicate on its surface 
with those of the other side, and with the ramifications of the thyroid 
branch. 

The inferior or thyroid branch (R. thyroideus) is the continuation 
of the trunk ; it sometimes furnishes many or even all the muscular 
branches which we have described as coming- from the laryngeal 
branch ; but small twigs always arise from it and go to the middle 
and inferior constrictors of the pharynx and to the crico-thyroideus 
muscle. After which it descends downward into the thyroid gland, 
and generally divides, at its upper extremity, into two branches, a 
posterior and inferior, and an anterior and superior, which soon sub- 
divide. The former penetrates posteriorly into the thyroid gland, and 
anastomoses along its posterior face with the branches of the inferior 
thyroid artery ; the other proceeds along its upper edge, gives oft con- 
siderable branches which expand on its anterior face, and anastomose, 
by very large vessels, with the synonymous branch of the opposite 
side. 

When the superior thyroid artery is divided into two separate trunks 
it often happens, but not always, as one might think from what several 
anatomists say, (2) that the laryngeal branch is distinct from the thy- 
roid branch, and situated above it. Sometimes however, but very 
rarely, the superior thyroid artery gives off only the trunk of the mus- 
cular branches and the laryngeal branch. 

IX. LINOUAL ARTERY. 

§ 1350. The second branch is the lingual artery (A. lingaalis, b 
sublingualis, s. ranina), which arises farther inward, most generally a 
few lines, and sometimes an inch, above the preceding, and rarely by a 

(1) We have remarked that this is the most common arrangement ; so that our 
observations in this respect agree with those of Mayer (toe. cit., p. 249), and with 
Bichat (loc. cit., p. 149), who both say that the laryngeal branch commonly penetrates 
into the larynx by passing between the hyoid bone and the thyroid cartilage. Mur- 
ray (loc. cit.. p. 11) indicates exactly these three arrangements, but does not say that 
the first is the most frequent. Scemmerring (p. 131) entirely neglects this, and speaks 
only of the two which are less frequent. Sabatier (p. 115) mentions only the third. 

(2) Mayer, {loc. cit., p. 49) asserts, but wrongly, that the laryngeal always arises a 

?uarter of an inch above the thyroid artery. Sabatier (loc. cit., p. 15) ; Soemmering 
lac. cit, p. 131); (Portal, loc. cit, p. 159). 



ANGEIOLOGV 235 

trunk in common with the superior thyroid artery, but more frequently, 
and nearly once in seven times, with the facial artery. It is generally 
a little larger than that we have mentioned. 

This artery curves considerably, and its convex part looks upward, 
passes then directly over the large horn of the hyoid bone, goes hori- 
zontally forward, glides between the middle constrictor of the pharynx 
and the hyoglossus muscle, and then ascends towards the base of the 
tongue, where it recommences, and then goes horizontally forward, 
along the inferior face of this organ. 

From its posterior part arise, 1st, several branches, which go to the 
hyo-glossus muscle and middle constrictor of the pharynx, and which, 
having passed through the latter, enter the digastricus and the thyro- 
hyoideus muscles, and the submaxillary gland ; 2d, a branch which 
goes downward and inward, between the genio-glossus and the genio- 
hyoideus muscles directly on the hyoid bone, gives branches to these 
muscles, especially to the first, and anastomoses with that of the oppo- 
site side. It is called the hyoid branch (JR. hyoideiis). 

From the central ascending part arise one or more dorsal arteries of 
the tongue (JR. dorsales linguas), which go downward to the posterior 
part of the tongue, on the inside of the hyo-glossus muscle, ascend 
upon the back of this organ, and advance to the epiglottis. 

The lingual artery divides, in front of the hyo-glossus muscle, into a 
ranine and a sublingual artery. 

The ranine artery (A. ranina) is larger than the other, and is a 
continuation of the trunk. It extends deeply between the lingualis 
and genio-glossus muscles, proceeds forward, gives off several branches 
in its course, and finally anastomoses with that of the opposite side, 
behind the summit of the tongue, at the upper end of its frenum. 

The sublingual artery {A. sublingualis) is more external and more 
superficial than the preceding. It passes over the mylo-glossus 
muscle, between it and the sublingual gland, gives off branches to if, 
to the hyo-glossus muscle, to the lingualis muscle, and to the proper 
membrane of the mouth, passes over the mylo-hyoideus muscle, and 
anastomoses with the inferior maxillary branch of the facial artery. 

This artery sometimes arises from the facial. 

III. FACIAL ARTEHY. 

§1351. The third branch, the facial or external maxillary artery 
{A. facialis, facialis anterior, angularis, maxillaris externa), varies in 
respect to its origin, size, and extent ; it is commonly the largest of 
the three anterior branches of the external carotid, and supplies all the 
anterior part of the face ; but sometimes also it extends only to the 
angle of the mouth, and, the other branches are supplied from the 
temporal artery. There is scarcely a vessel which varies so much a# 
this, even in the two sides of the same body. 



20.y DESCRIPTIVE ANAT0>1\ 

It passes under the posterior belly of the digastricus muscle to go to 
the angle of the lower jaw. In this place it proceeds first horizontally 
behind and within the inferior edge of the lower jaw, then goes ob- 
liquely upward and forward on the inside of this bone and of the upper 
jaw. 

It frequently gives off, directly above its origin, the inferior or 
ascending- palatine artery {A. palatina ascendens, s. inferior), which 
usually arises from the ascending or inferior pharyngeal artery (.#. 
pharyngcea ascendens) ; we shall describe it with'that. 

It then gives small ramuscules to the digastricus and stylo-hyoideus 
muscles. 

Farther on, it gives off considerable branches which go to the sub- 
maxillary gland (R. glandulares), and goes forward in one of its 
grooves. Farther onward, it gives off one or more ramuscules to the 
pterygoideus internus muscle. 

It then furnishes the submental artery (R. submenialis). This arises 
near the lower edge of the lower jaw, and proceeds along it, directly 
below the attachment of the mylo-hyoideus muscle, and over the ante- 
rior belly of the digastricus muscle, gives ramuscules to both of these 
muscles, anastomoses with the sublingual artery, and thus goes forward, 
where it communicates with that of the opposite sid«, on the centre of 
the lower edge of the lower jaw. Thence it reascends into the sub- 
stance of the lower lip, to which it gives twigs, as also to the skin of 
the chin, and anastomoses with the descending branches of the coro- 
nary artery of the lower lip, and also with those of the inferior, dentar 
artery, which emerges from the mental foramen. 

When the sublingual artery is a branch of the 'facial it arises a little, 
and even in most cases directly before the submental. 

The continuation of the trunk, or the proper facial artery, turns upon 
the lower edge of the lower jaw, generally directly before the anterior 
edge of its ascending branch, thus attains the outer face of this bone, de- 
scends very obliquely between the masseter and the triangularis oris 
muscles, arrives at the angle of the lips, and gives off in this place 
several branches, which enter the masseter, the triangularis and the 
buccinator muscles and the skin. 

About the centre of the space between the angle of the mouth and 
the under edge of the lower jaw, it generally divides into two branches. 
One, the continuation of the trunk, goes directly upward ; the other is 
smaller, and proceeds more obliquely inward and forward. 

The latter is the inferior coronary artery of the lip (j2. coronaria labii 
inferioris). It passes under the triangularis oris muscle and proceeds, 
toward the lower lip, gives several branches to this muscle, to the levator 
menti, and also to the membrane of the mouth, and anastomoses both 
with its fellow of the opposite side and with the twigs of the submental 
and inferior dentar artery. 

This artery is sometimes much smaller on one side than on the other. 
In some subjects it is even entirely deficient, and is then replaced by 



ANGElOLOGt. 237 

that of the opposite side. Sometimes it arises much higher and comes 
from'the superior coronary artery of the lip. In some cases it is double : 
one of the two then arises much above the other ; but the two arteries 
taken together are not larger than that of the opposite side : sometimes 
the two branches into which the lower coronary artery of the lips is 
divided are very small. 

After giving off this branch, the facial artery winds tortuously up- 
ward and inward. Arrived as high as the angle of the mouth, it gene- 
rally divides, a little above this point, into two branches. 

The larger goes inward and forward, between the fibres of the orbi- 
cularis oris, and is called the superior coronary artery (Jl. coronaria 
labii superioris). This artery proceeds directly over the loose edge of 
the upper lip, gives ramuscules to the orbicularis oris, to the levator 
labii superioris, to the skin, to the buccal membrane, meets that of the 
opposite side and anastomoses with it by a broad communication similar 
to that between the inferior coronary arteries. The two coronary arteries 
usually anastomose together in two places by large branches : some- 
times the anastomosis between the arteries is very small on one side, 
but is replaced by a very large branch, which arises higher up from 
the facial and which communicates with the artery of the septum of 
the nose. 

Both coronary arteries are very tortuous, but the upper is more so 
than the lower. Both anastomose with the synonymous arteries of the 
opposite side, and these anastomoses are proportionally the largest in 
the body, when we consider the vessels between which they occur. 

The superior coronary artery always gives off from its centre, where 
it anastomoses with that of the opposite side, a branch, which goes 
upward toward the nasal septum, which is called the artery of the sep- 
tum of the nose (Jl. nasalis septi). Sometimes this artery is single, some- 
times double, and even triple, at its origin : in the last two cases it is fre- 
quently given off by the coronary artery of one side ; but however this 
may be, it divides near the septum of the nasal fossa? into at least two 
branches, a right and a left, each of which proceeds along the lower 
edge of the septum and the inner part of the corresponding nostril to the 
end of the nose, and also sends ramuscules, which reascend on the 
cartilaginous septum. 

Besides these branches, the coronary artery gives off sometimes be- 
fore, more externally and on one side only, or on both, another consi- 
derable branch (JR. pinnalis), which goes to the ala and the outer part 
of the nostril ; but this branch more frequently comes from the next 
one. 

The facial artery, after giving off the superior coronary, consists 
only of a smaller branch, which may be called the common external 
nasal artery (Jl. nasalis externa communis). This artery is very tortu- 
ous, and ascends obliquely forward under the levator labii superioris 
muscles, to which it gives ramuscules, goes toward the nose, and anas- 
tomoses by considerable branches with the infra-orbitar artery. It 



238 



DESCRIPTIVE ANAT0MY 



usually gives off, opposite the nostril, the lateral arteries of the nose 
(R. pinnales, s. laterales nasi), and also sends off numerous smaller 
arterial twigs, which anastomose with each other and also with those 
of the septum and their corresponding ones of the opposite side, which 
are called the dorsal arteries (R. nasales dorsales), and which always 
communicate on the nose by several large or small branches with the 
ophthalmic artery. Finally, it terminates on the back and side of the 
nose, and never, even in its greatest degree of extension, goes beyond 
the upper edge of the cartilaginous portion of this organ. 

The two coronary and the common external nasal artery, and more 
frequently only the superior coronary and the latter, sometimes arise 
not only from the above facial but also from the transverse facial 
artery, which then is much larger, while the other is smaller, although 
the facial artery is not necessarily more developed at its lower part ; 
we likewise observe in other subjects that this artery is very much de- 
veloped at its upper part, although the lower part does not produce 
more branches than usual. We have seen the sublingual artery coming 
from it at least several times, and the facial artery at the same time 
was as large as usual. In other cases, on the contrary, it gives off 
neither of the two coronary arteries, while the sublingual artery arose 
as usual ; but the submental artery was uncommonly small. 

Hence it appears that the facial artery is always the principal source 
of communication, 1st, between the superficial and the deep-seated 
branches of the external carotid by its anastomoses with the infra-orbitar, 
the nasal, and the dentar arteries ; 2d, between the external and the 
internal carotid arteries by its anastomosing with the ophthalmic 
artery. 

§ 1352. Numerous small branches, which go to the masseter and 
pterygoidei muscles and to the parotid gland(.R. masseterici,pterygoidei, 
et parotidei), arise externally and internally from that part of the carotid 
artery situated between the ascending branch of the lower jaw and the 

ear. 

A larger anterior branch, the transverse facial artery, which will be 
described hereafter, rarely arises from its upper extremity, directly below 
its division. 

B. INNER BRANCH. 

I. ASCENDING OR INFERIOR PHARYNGEAL ARTERY. 

§ 1353. Most generally only one branch arises from the inner face 
of the external carotid artery ; this is the ascending or inferior pharyn- 
geal artery (A. pharyngoza ascendens, s. inferior, s. posterior), which 
comes sometimes from the bifurcation of the primitive carotid, some- 
?imes from the origin of the internal carotid, but more frequently from 



ANGEIOLOGY. 239 

the occipital artery,(l) and is sometimes replaced by the branches of 
the facial artery. 

If it is a branch of the external carotid, it arises very deeply, most 
generally above the inferior thyroid artery ; so that it is the second 
branch from the trunk . but sometimes it comes higher up and even 
above the facial artery.(2) 

It is sometimes double : then the two inferior pharyngeal arteries 
rarely come from the external carotid ; one arises from the latter, and 
the other from one of the secondary branches above described, or from 
the internal carotid artery.(3) 

It is always the smallest branch of the external carotid artery. 

It goes perpendicularly upward, on the inside of the external carotid 
artery, and in the same direction with it, between it and the pharynx. 

It gives off first the descending branches to the constrictors of the 
pharynx, and to the anterior and lateral muscles of the neck. 

A little farther it divides into two branches, one of which, the pha- 
ryngeal branch, (R. pharyngceus) is distributed principally to the con- 
strictors of the pharynx, and communicates with the pharyngeal 
branches of the superior thyroid artery ; the other is termed the poste- 
rior meningeal artery, {A. meningcea posterior) ascends through the 
posterior foramen lacerum of the skull, or through a special opening 
near the occipital condyle, and is distributed to that part of the dura 
mater which lines the lower part of the skull. 

C. POSTERIOR BRANCHES. 

§ 1354. The posterior branches of the external carotid artery are, 
1st the occipital, and 2d the posterior auricular artery. 

1. OCCIPITAL ARTERY. 

§ 1355. The occipital artery (A. occipitalis) is a considerable 
branch, but much smaller than the three anterior branches, which usu- 
ally arise opposite the lingual or the facial artery ; seldom or never 
above or below them. It rarely comes from the internal carotid artery. 
It is very deeply situated ; goes upward and backward, often gives off, 
soon after arising, branches which go to the posterior belly of the di- 
gastric us muscle of the lower jaw, then a descending branch, which 

(1) Scemmerring states that it sometimes arises from the superior thyroid artery. 
We have never seen this, nor is it mentioned by any other anatomist. Scemmerring, 
it is true, quotes Mayer ; but the laryngo-pharyngean artery (A. laryngo-pharyngcea) 
described by Mayer, is the laryngeal branch of the superior thyroid artery, and de- 
scribes the inferior pharyngeal artery as the posterior artery of the throat. 

(2) Bichat asserts that it arises between the facial and lingual arteries. Our ob- 
servations lead us to think that Scemmerring is more correct in saying that it rarely 
arises higher than the lingual. Murray places it behind the facial, but adds that 
its origin is near that of the lingual. Portal also places it nearly opposite this latter, 
as do Sabatier and Mayer. Boyer states that it arises opposite the facial. 

(3) Soemmering asserts that when it is double, the lower trunk arises from the pri- 
m tive carotid, and the superior from the internal carotid. This arrangement exists 

,sometimes, but it is not the law. That mentioned by us is much more common. 



240 DESCRIPTIVE ANATOMi 

goes to the sterno-cleido-mastoideus muscle and the upper lymphatic 
glands of the neck, higher up, gives off wholly or partially the ascend- 
ing pharyngeal artery, then extends below and deeply between the 
transverse process of the first cervical vertebra and the mastoid process 
of the temporal bone, continues its course backward, passing under the 
complexus minor muscle, then assumes a horizontal direction, gives 
branches to the upper extremity of the sterno-cleido mastoideus, to the 
complexus minor, to the transversalis colli, to the small lateral and 
posterior muscles of the head, and then ascends on the occipital bone, 
covered by the upper part of the splenius muscle, to which it gives 
branches. It is then called the superficial occipital artery, proceeds 
directly below the skin, on this bone to the vertex, terminates in a large 
anastomosis, formed by its branches with each other and with those 
of the frontal, the superficial temporal and the sjnonymous artery of 
the opposite side. 

At the place where the occipital artery leaves the space between the 
transverse process of the first cervical vertebra and the mastoid process 
of the temporal bone, to pass on the obliquus capitis major muscle of 
the head, it always gives a deep or descending branch. This branch 
being sometimes very considerable, and nearly as large as the continu- 
ation of the trunk, we may then admit that the artery divides at this 
place into a superficial and deep-seated branch. When this is the 
case, it descends to the middle of the back, between the splenius, com- 
plexus, digastricus and transversalis colli muscles. Sometimes, how- 
ever, it is very small, and then it is distributed in the small poste- 
rior muscles of the head. 

The deep-seated branch anastomoses many times with the vertebral 
artery, and with the cervical branches of the inferior thyroid artery. 

From the superficial occipital artery constantly arise one of several 
branches, which pass into the cranium through the mastoid foramina ; 
more rarely through the large occipital foramen or the foramen lace- 
rum, which are distributed to the posterior and inferior part of the 
dura mater. They are termed the posterior meningeal arteries. (.#. 
meningeal posteriores ah occipitali.) 

2. POSTERIOR AURICULAR ARTERY. 

§1356. The posterior auricular artery (A. auricularis posterior) is 
generally much smaller than the preceding, and arises a little above it, 
in the substance of the parotid gland, and is generally separated from 
it only by the stylo-hyoideus muscle. Sometimes it arises from this 
artery, and rarely somewhat higher, directly below the division of the 
external carotid artery into the superficial temporal and the internal 
maxillary artery. It goes upward, at the side and behind the trunk 
of the external carotid artery, and passes through the parotid gland, 
near the mastoid process. There it gives, 1st at its lower posterior 



ANGEIOLOGT. 241 

part, branches which go to this gland, to the posterior belly of the digas- 
tricus muscle, to the stylo-hyoideus and to the upper part of the sterno- 
cleido-mastoideus muscles ; 2d, from its superior and anterior part, an 
ascending branch, the stylo-mastoid artery (A. stylo-mastoidea), which 
furnishes ramusculesto the auditory passage, penetrates into the canal of 
the facial nerve through the stylo-mastoid foramen, distributes itself to 
the mastoid process, to'the tympanum, and also to a portion of the laby- 
rinth, and anastomoses with a branch of the middle meningeal artery. 
The trunk of the artery then divides at the level of the mastoid pro- 
cess into two branches, an inferior' or muscular and a superior or auri- 
cular branch. 

The inferior branch goes transversely outward, over the upper part 
of the splenii muscles, gives ramuscules to these muscles, to the trape- 
zius and to the skin, anastomoses with the superficial occipital artery, 
and advances toward the occiput. 

The superior branch goes upward and backward. It usually divides 
into two or three branches, one of which, the more transverse, goes 
backward to the mastoid process, and gives branches to it, also to the 
occipitalis muscle ; while the other, or the others, attain the posterior 
part of the concha, distribute the small arteries to the retrahentes 
auriculae, and to the transversus auriculas muscles, then pass over 
the concha, and thus come on its internal face, where they lose them- 
selves in the skin and the mucous membrane. 

D. TERMINATION OP THE EXTERNAL CAROTID ARTERY. 

§ 1357. The external carotid artery terminates at the neck of the 
lower jaw in two trunks, a superficial, the temporal artery ; the other 
deep-seated, the internal maxillary artery. 

I. TEMPORAL ARTERV. 

§ 1358. The temporal artery (A. temporalis) is smaller and more 
superficial than the internal maxillary, and continues in the direction 
of the trunk. It goes upward and outward. Its branches may be 
divided into anterior and posterior. 

The anterior branches are principally the following: 

1st. The first branch is often the upper masseteric artery (A. masse- 
terica superior) which penetrates sometimes to the external and some- 
times to the internal layer of the masseter muscle, but frequently 
comes from the next. 

2d. The transverse facial artery (A. transversa, s. transversalis 
faciei){i) is the second, often the first branch of the artery, and arises 

(1) Soemmering (loc. cit.. p. 196) mentions it as arising from the external carotid 
artery, before it bifurcates, and says also that it sometimes comes from the internal 
carotid artery, and cites as authorities Mayer, Murray, and Walter. But Murray 
states expressly that it is the fourth branch of the external temporal artery (p. 17). 

Vol. II. 31 



242 DESCRIPTIVE ANATOMY. 

directly above the bifurcation of the external carotid arter}'. Some- 
times, but unfrequently, it arises from tho external carotid artery, and 
most generally from the bifurcation. It goes forward, with the i 
of Stenon, on the masseter muscle, directly below its up] gives 

off the superior masseteric artery, when this does not come from ihe 
temporal artery, sends several ramuscules to the skin, penetrates for- 
ward into a greater or less portion of the orbicularis palpebrarum mus- 
cle, and anastomoses, by a considerable number of ramifications, with 
the facial artery, which it meets, and with the infra-orbit ar artery. 
Sometimes this gives off all the upper part of the facial artery. 

In some subjects its ascending ramuscules extend much higher, and 
reach the outer extremity of the edge of the orbit. 

The middle temporal artery {A. temporalis media) generally arises 
some lines above the transverse facial artery, a little below the malar 
bone, a considerable branch, which proceeds first from below upward, 
gives off one or several ramuscules to the upper part of the masseter 
muscle, then curves backward at a right angle, between the trunk 
and the temporal muscle, and terminates partly in small twigs, which 
penetrate into the substance of the muscle where they anastomose 
with those of the deep temporal artery, and partly in superficial 
branches, which are distributed on the auditory passage, where they 
communicate with those of the posterior auricular artery. 

After giving off this artery, the trunk of the temporal artery goes 
upward and forward, on the temporal muscle, directly under the skin, 
and describes a considerable arch, which is convex posteriorly and 
terminates as the anterior temporal artery (Jl. temporalis anterior), 
anastomosing several times with the superciliary artery, and giving 
branches to the frontalis muscle, and to the skin of the forehead. 

Small inconstant branches come from the anterior and concave part 
of the arch which it describes, these go forward into the outer part of 
the orbicularis palpebrarum muscle, and communicate with the ascend- 
ing branches of the transverse facial, and also with the upper ramus- 
cules of the anterior temporal artery. 

The posterior branches of the superficial temporal artery are, 

1st. The anterior inferior auricular arteries (Jl. auricular es anterior es 
inferiores), usually three or four in number, which arise directly above 
one another from its lower part, and are expanded in the inferior and 
anterior part of the concha. 

2d. The anterior and stiperior auricular artery (Jl. auricularis ante- 
rior superior) which is often single, rarely double ; it arises nearly 
opposite the preceding branches, and goes to the upper and anterior 
part of the concha, and to the attollens auriculae muscle. 

Mayer describes it as the tenth branch of the external carotid artery (p. 84), but 
asserts positively that it arises about a line above the internal maxillary artery. 
The descriptions of Portal (p. 186), Boycr (p. 42), Bichat (p. 152), and Mcnon (p. 267), 
agree, like that of Murray, with the results of our observations. 



ANGEIOLOGY. 243 

3d. Two or three larger branches usually go backward, inward, 
and upward, and anastomose with each other and with those of the 
opposite side, and with the superficial occipital artery, which some- 
times partly replaces them. They are called the posterior temporal 
arteries (A. temporaries posterior es), and they are usually wrongly con- 
sidered as forming, in opposition to the anterior temporal artery, but 
one branch. 

II. INTERNAL MAXILLARY ARTERY. 

§ 1359. The internal maxillarij artery {A. maxillaris interna, A. 
orbito-maxillaris) is larger than the preceding, but differs more from 
the direction of the primitive trunk, and is situated more deeply, so that 
it cannot be seen entirely till the zygomatic arch and the outer part of 
the body of the upper maxillary bone is removed. 

Its direction changes several times in its course. First, it goes 
transversely inward and a little forward, behind the neck of the jaw ; 
then it goes directly inward, and passes between the two pterygoidei 
muscles, or curves again a little forward. Arrived at the pterygoid 
process, it goes perpendicularly upward, over the pterygoideus extern us 
muscle, and is reflected on itself as high as the floor of the orbit, so that 
its direction becomes horizontal. Thence it divides into several 
branches which descend more or less, by which it terminates, distri- 
buting itself on one side on the inner and posterior part of the nose, on 
the other to the outer part of the face. 

Proceeding in this manner, it distributes the blood to the dura mater, 
to the internal ear, to the pterygoidei muscles, to the temporalis muscle, 
to the teeth, to the interior part of the nose, to the upper part of the 
pharynx, and to a part of the face, and communicates with several 
branches of the external and internal carotid, by the following 
branches, which are successively given off. It usually sends one or 
two to the ear, viz : 

a. The deep-seated auricular artery {A. auricularis profunda), which 
goes to the organ of hearing. 

b. The artery of the tympanum (A. tympanica), which is distributed 
to the temporo-maxillary articulation, and then penetrates into the 
cavity of the tympanum, through the fissure of Glaser. These two 
branches often arise from the external carotid artery, or from the facial 
or temporal artery. 

c. The small meningeal or the external pterygoid artery (A.meningea 
parva, s. pterygoidea externa) is an inconstant branch, which often 
arises from the middle meningeal or from a pterygoid artery ; it gives 
branches to the pterygoidei muscles, to the muscles of the soft palate, 
and to the dura mater, near the sella turcica, and sometimes pene- 
trates into the skull through the foramen ovale. 



244 DESCRIPTIVE ANATOMY. 

d. The middle, or great meningeal, or spheno-spinal artery (Jl. me- 
ninges media, s. magna, s. spinosa),(l) is the largest branch of the 
internal maxillary artery. 

It arises from the upper part of the origin of the internal maxillary 
artery. It goes directly upward and gives off branches to the ptery- 
goids muscles, to the upper constrictor of the pharynx, to the temporal 
muscle, and to the muscles of the soft palate ; these are sometimes, 
although rarely, deficient. When they do not exist they are replaced 
by the small meningeal artery. 

The artery then, either simple or divided, enters through the spheno- 
occipital hole of the sphenoid bone, into the skull, and then gives off 
some ramifications posteriorly, which glide into the fissure of Fallopius, 
penetrate into the cavity of the tympanum and the canal of the facial 
nerve, are distributed to the membrane of the tympanum, to these nerves, 
and to the muscles of the tympanum, and anastomose with the stylo- 
mastoid artery. Others, which are anterior, sometimes penetrate into 
the orbit, through the malar bone or the large wing of the sphenoid 
bone, and to the lachrymal gland. But this trunk, covered on the 
outer face of the dura mater, above which it projects, and of which it 
is the largest artery, expands principally in the anterior and central 
part of this membrane. It arises, near the anterior edge of the parietal 
bone, at the median line of the skull, and gives off, forward and back- 
ward, numerous branches, which anastomose with the other branches 
of the middle, and also with those of the anterior and posterior menin- 
gceal arteries. 

Besides, these branches communicate also with those of the temporal 
and occipital arteries. 

As they project above the dura mater, and follow the grooves of the 
skull-bones, these indicate their course very well. 

e. The inferior maxillary or inferior denial artery (A. maxillaris, s. 
alveolaris, s. dentalis inferior), which sometimes arises from the middle 
meningceal artery, and always comes from the lower point of the origin 
of the internal maxillary artery, descends between the two pterygoidei 
muscles, to which it gives twigs, and also sometimes to the temporal 
muscle ; penetrates into the dental canal, through which it passes for- 
ward, gives ramifications to all the teeth and to all the lower dental 
nerves, which occupy the same canals as they do, then emerges from 
the mental foramen, and anastomoses above with the inferior coronary 
or labial, and below with the submental artery, and produced, like the 
preceding, by the facial artery. 

(1) Some anatomists, asSabatier, Boyer, and Bichat, state that it is the first branch 
of the internal maxillary artery. We have always seen it preceded by one or more 
of those we have mentioned, and we have never found it, as Mayer states, arising 
directly from the bifurcation of the external carotid artery. According 1 to our obser- 
vations, it does not normally arise before the inferior dentar artery, as Soemmering, 
Murray, and Munroe assert. We have seen that Portal waa correct in saying that it 
is given off as frequently after it or at least opposite to it. 



ANGEIOLOGY. 245 

This emerging branch most commonly arises at some distance from 
the mental foramen, within the dental canal, and on a level with the 
small malar teeth, at the place where the inferior maxillary artery 
bifurcates to produce it and the continuation of the trunk. 

/ g. Two or more deep-seattd temporal branches (-R. temporalis 
profundi) arise from the upper part of the maxillary, and are distri- 
buted to the buccinator and the pterygoidei muscles, and especially 
to the temporal muscle ; penetrate also into the orbit, where they send 
branches into the lachrymal gland and the eyelids, and anastomose 
extensirely with the ophthalmic artery. 

h. The masseter artery (R. massetericus) is not constant, and arises 
sometimes from the external temporal, or even the external carotid, or 
finally from one of the deep pterygoid arteries. It passes over the 
semicircular notch of the lower jaw into the upper part of the masseter 
muscle. It gives branches also to the temporal muscle, and to the 
two pterygoidei muscles, especially to the external. 

i. The buccal artery {A. buccalis, s. buccinatoria) is a very con- 
stant branch, although it often arises from the deep temporal artery, 
or from one of the following branches. It comes from the lower part 
of the inferior maxillary artery, goes downward and forward, along the 
outer face of the body of the upper jaw, distributes its branches in the 
buccinator muscles, the muscles of the upper lip, the lower part of the 
orbicularis palpebrarum muscle, the buccal membrane, sometimes also 
the anterior teeth to which it comes by several openings which exist 
in the upper part of the superior maxillary bone, and anastomoses with 
the branches of the facial, and also with those of the infra-orbital, artery. 

k. The superior maxillary or alveolar artery (A. maxillaris supe- 
rior, s. alveolaris) arises sometimes from one of the deep temporal 
or from the infra-orbital artery. It is larger than the preceding, goes 
a little downward and forward, turns on the upper maxillary bone, and 
sends off numerous large and small branches, one of which is termed 
the superior dental artery (R. dentalis superior) into the teeth of the 
upper jaw. These branches nourish the dental capsules, the perios- 
teum, the germ, the buccinator muscle, the zygomatic us major mus- 
cle, and anastomose with the branches of the facial and infra-orbital 
arteries. 

/. The infra-orbital artery (A. infra-orbitalis) is generally smaller 
than the preceding, and arises near the bottom of the orbit. It soon 
engages itself in the infra-orbital foramen, and the infra-orbital canal 
sends some branches into the orbit and the maxillary sinus, emerges 
by the infra-orbital foramen, behind the levator labii superioris, thus 
comes on the front of the face, and terminates in a great many ra- 
muscules, some of which go to the muscles of the upper lip while 
the others anastomose with the upper dental artery, the dorsal 'artery 
of the nose, the orbitar and the palatine artery. 

Finally, at the upper end of the zygomatic fossa, the internal max- 
illary artery divides into an ascending and a descending branch, which 
goes inward. 



246 DESCRIPTIVE ANATOMY. 

m. The superior palatine artery (A.palatina suprcma, s. descendens, 
8.pterygo-palatina)g{ves off, first, the supeiior or descending pharyngeal 
artery {A. pharyng&a svprema, s. descendens). This passes through the 
pterygopalatine foramen, and expands in the pterygoid process of the 

bone,and theEustachian tube and the upper part of the pharynx. Some- 
times it arises from the internal maxillary artery by a distinct trunk. 
The superior palatine artery descends in the pterygoid canal and 
divides into several ramuscules, which pass through different openings, 
to go to the soft parts of the palate. The trunk passes through the 
posterior palatine canal, comes on the palatine arch, rests directly on 
its lower face, describes a right angle to go forward, forming numerous 
curves, in its course gives off twigs to the mucous membrane of the 
palate and to the muciparous glands, and anastomoses forward with 
that of the opposite side, and sends its latter branches through the 
anterior palatine foramen into the nasal cavity, where they extend to 
the lower turbinated bone, communicating with the branches of the 
artery of the septum and of that of the dorsum of the nose which arise 
from the facial artery. 

n. The last branch, the posterior nasal or spheno-palatine artery 
(A. nasalis posterior, s. spheno-palatina) , enters through the spheno- 
palatine hole into the posterior part of the nasal fossa, and divides into 
two branches, an external and an internal, and sometimes into three. 

The internal branch, the posterior artery of the septum of the nose 
(A. septi narium posterior), descends along the posterior part of the 
septum of the nose, sends ramuscules to the upper part of the pharynx, 
and penetrates into the posterior cellules of the ethmoid bone, and also 
into the upper turbinated bone. 

The external branch descends along the outer edge of the posterior 
opening of the nasal fossa;, and usually divides into two ramuscules, 
which go, the upper to the middle, and the lower to the lower turbinated 
bone. These ramuscules arc distributed principally in the posterior 
part of the nasal fossa and of the maxillary sinus. 

II. INTERNAL CAROTID ARTERY. 

§ 1360. The internal carotid or anterior cerebral artery (A. carotis 
interna, s. cerebralis, s. cerebralis anterior, s. encephalica) is usually 
smaller than the external, ascends behind it, before the internal jugular 
vein, on the outside of the pneumo-gastric nerve, directly before the 
vertebral column, to the lower orifice of the carotid canal. It does not 
generally bend much, although it is sometimes very tortuous, and it is 
rarely straight. 

It seldom gives off branches in this course. It rarely in fact furnishes 
one of the internal or posterior branches of the external carotid or of 
the occipital artery. The latter comes from them less frequent I; 
the others. Upward it gives off sometimes a small branch, which 
id the palatine region and to the velum palati. 



ANGEIOLOGV. 247 

Immediately below its entrance into the carotid canal it is generally 
almost horizontal, or at least goes obliquely upward and forward. At 
the lower part of this canal it goes vertically upward. It afterwards 
goes forward at nearly a right angle, and becomes almost horizontal, 
although it ascends a little. After leaving the canal it resumes its pri- 
mitive direction upward, but proeeeds at the same time forward and 
inward, and thus comes on the side of the sella turcica. At the poste- 
rior part of this excavation it curves a second time at a right angle, 
goes horizontally in the lateral carotid groove, going outward and a 
little downward. In this part of its course it accompanies the ca- 
vernous sinus of the dura mater, both being inclosed in the same por- 
tion of the dura mater, but separated by its proper membrane from the 
blood which it contains. At the anterior extremity of the lateral face 
of the sella turcica, below the anterior clinoid process, it describes a third 
right angle, and goes upward, backward, and inward. In its course it 
gives off very trifling branches to the internal ear, to the dura mater, 
and to the third, fourth, fifth, and sixth pairs of nerves. Opposite the 
internal extremity of the upper orbitarfissure it divides into two branches, 
the continuation of the trunk which goes to the brain, and the ophthal- 
mic artery. 

Thus it changes its direction five times at least, and this arrange- 
ment retards the course of the blood much more, inasmuch as all the 
curves are sudden and do not occur on the same plane. 

The internal carotid artery is intimately united by a very short cel- 
lular tissue to the canal through which it passes and which it almost 
entirely fills. 

I. OPHTHALMIC AETEBY. 

§ 1361. The ophthalmic artery {A. ophthalmica) is a very conside- 
rable branch, which exceeds in volume all those hitherto mentioned. It 
is always single. It leaves the skull through the optic foramen, usually 
on the outer and lower side, rarely at the upper part of the optic nerve, 
penetrates into the orbit, sends numerous branches to all parts of the 
eye, and also larger or smaller branches into the nasal fossa? and the 
face. 

Having come into the cavity of the orbit, it soon ascends on the optic 
nerve, goes upward and inward, passes between this nerve and the 
rectus superior muscle of the eye, and thus arrives at the inner part of 
the orbit and goes forward to the internal angle of the eye. 

Its branches vary surprisingly in respect to their origins, their number 
and their volume. The principal are : 

1st. Usually but not always an external posterior ciliary artery (A. 
ciharis posterior), which arises from the outer side of the ophthalmic 
artery, goes forward along the optic nerve on its outer and lower side, 
and penetrates the sclerotica directly before the anterior extremity of 
this nerve. 



248 DESCRIPTIVE ANATOMY. 

2d. The lacrymul artery (A. lacrymalis) arises from the upper part 
of the ophthalmic artery, generally far backward and sometimes very 
far forward. It rarely arises from the middle meningeal artery, in 
which case it enters into the orbit, through the upper orbicular fissure, 
or through a special opening either in the malar bone or in the large 
wing of the sphenoid bone. It proceeds outwardly under the rectus 
superior muscle, to which it gives branches, and also to the rectus ex- 
ternus and to the levator palpebrarum muscles. It sometimes sends 
several through the malar bone into the temporal muscle, where they 
anastomose with those of the deep temporal artery. In some subjects 
one or several ciliary arteries arise from it. It then passes across, 
above or below the lacrymal gland, leaves the orbit at the external 
angle of the eye, anastomoses with the palpebral artery given off by 
the ophthalmic artery to form the palpebral arch, and terminates in 
the orbicularis palpebrarum muscle, the skin of the eyelids, and the 
tunica conjunctiva. 

3d. The posterior upper ciliary artery (A. ciliaris posterior, superior) 
is distributed in the same manner as the external, but gives off no 
branch after passing through the tunica sclerotica. - Sometimes all the 
posterior ciliary arteries arise after the posterior ethmoidal artery ; but 
they always proceed very tortuously on the surface of the optic nerve, 
and after dividing into numerous branches, pass through the posterior 
part of the sclerotica to enter the eye, where they are distibuted in the 
manner stated in describing that organ. 

4th. Next, a small inconstant branch arises and goes to the posterior 
part of the rectus superior muscle. 

5th. The posterior or middle ethmoidal artery (A. ethmoidalis poste- 
rior, s. media) is also inconstant, and often arises from the lacrymal 
artery, from the anterior ethmoidal, or from the supra-orbitar artery. (1) 

It gives first branches to the origin of the obliquus superior, rectus 
internus and externus muscles, then goes inward over the obliquus 
superior muscle, passes through the ethmoidal or posterior internal or- 
bitar foramen, comes into the nasal fossae, and is distributed to the pos- 
terior ethmoidal cellules, the sphenoidal sinus, and the antrum High- 
morianum ; it anastomoses with the branches of the posterior nasal or 
spheno-palatine artery and with the anterior ethmoidal artery, then re- 
enters the skull through a small canal in the ethmoid bone, gives 
ramuscules to the periosteum which covers the anterior and central 
fossa of the base of the skull, and terminates by again passing into the 
nasal fossae through the openings in the cribriform plate. 

6th. The central artery of the retina (A. centralis retina), arises far- 
ther back, directly from the ophthalmic artery, or from the preceding, 
or from the lacrymal •ertery, or from one of the two muscular branches ; 

(1) But it is not always the smallest, as Bichat asserts ; we have remarked several 
times that it was one of the largest branches and much larger than the anterior. 



aN(;eiolo(;y. 249 

it goes into the optic nerve, proceeds forward along us axis, and distri- 
butes itself to the retina, as we shall Haentioo in describing the eye. 

7th. The inferior muscular artery (A. muscularis inferior), is a con- 
siderable and rather constant branch, which sometimes gives off the 
central artery of the retina and one or more of the ciliary arteries, goes 
inward, sends branches to the rectus internus and inferior muscles of 
the eye, and penetrates even into the nasal fossae. 

8th. The superior muscular or supra-orbitar artery (Jl. muscularis 
superior, s. supra-orbilaria) is less constant than ihc preceding, but it 
comes from the lachrymal less frequently than from the ophthalmic 
artery. It proceeds forward directly below the orbitav plate, leaves the 
orbit through the supra-orbitar foramen, gives off branches to the frontal 
bone, to its periosteum, to the supraciliaris and orbicularis palpebrarum 
muscles, and to the skin of the forehead, and anastomoses with the 
other branches of the ophthalmic and with the temporal artery. 

The anterior ciliary arteries (Jl. ciliares anticoz) arise from this branch 
and from the preceding ; they divide into fewer branches than the pos- 
terior, and enter the sclerotica much farther forward than the latter, 
near the transparent cornea. 

The branches we have described generally arise near the floor of the 
orbit, not far from each other ; hence why they are generally long. 
After giving them off, the ophthalmic artery is usually smaller and 
proceeds along the internal wall of the orbit, describing numerous 
curves. Towards the anterior opening of the orbitar cavity it gives off, 

9th. The anterior ethmoidal artery (.Jl. ethmoidalis anterior), which 
goes directly inward, passing over the obliquus superior muscle, and 
penetrates through the ethmoidal or anterior internal orbitar foramen 
into the nasal cavity, where it is distributed to the anterior ethmoidal 
cells and the frontal sinuses, and anastomoses with the other nasal 
arteries. It also sends off branches to the anterior region of the dura 
mater. 

The ophthalmic artery now proceeds a short distance within the 
orbit, afterwards leaves this cavity at the inner angle of the eye, and 
terminates in giving origin to, 

10th. The palpebral arteries (Jl. palp ebr ales). These arise some- 
times by a common trunk (palpebralis communis) and sometimes sepa- 
rately, the superior a little before the inferior, and go outwardly. 
They are distributed partly to the conjunctiva, partly and parti- 
cularly to the eyelids, in which they disappear between the skin 
and the orbicularis muscle. They divide there principally into two 
branches, one of which proceeds near the edge (ramus marginalis), 
while the other goes obliquely outward along the base of the eyelid. 

The superior palpebral artery anastomoses in this place with the 
lachrymal, the superciliary branch of the frontal, and even some branches 
of the anterior temporal artery. It also forms a single or double supe- 
rior palpebral arch (arcus tarseus superior), which communicate with, 
each other by numerous ramuscules, and thus form a net-work. 

Vor. II. 32 



250 



DESCRIPTIVE ANATOMY. 



The inferior palpebral arch {anus larseus inferior) is produced in the 
same manner, by the anastomosis of the inferior palpebral with the 
infra-orbitar, the lachrymal and the nasal arteries. 

All the parts of the eyelids are abundantly provided with vessels by 
these arterial branches. 

11th. The frontal artery {Jl. frontalis), which also ascends soon 
after arising, usually divides immediately into three branches, the supra- 
ciliary artery {A. snpracilia>-is), the superficial or subcutaneous frontal 
artery {A. frontalis subcutanea), and the deep frontal artery {A. fron- 
talis profunda) . By this division it is distributed, 1st, to the upper part 
of the orbicularis palpebrarum and corrugator supercilii muscles ; 2d, 
to the frontalis muscle and to the skin of the forehead ; 3d, to the frontal 
sinus. It extends to the coronal suture and to the temporal region, 
where it anastomoses with the branches of the external temporal artery ; 
it also communicates in other parts with those of the supra-orbitar and 
lachrymal arteries. 

12th. The nasal artery {A. nasalis) varies much in volume. Some- 
times it is a very small branch, terminating at the root of the nose ; 
sometimes it forms the continuation of the trunk of the ophthalmic 
artery, descends very low, contributes with the lateral nasal branch of 
the facial artery to produce the dorsal artery of the nose, extends to 
the end of the nose, proceeding on the side of this organ, always anas- 
tomoses with the inferior palpebral and the facial artery, and gives 
ramuscules to the integuments and to the nasal bones, to the frontalis 
muscle, to the internal part of the orbicularis palpebrarum, to the mus- 
cles of the nose, and even to the pituitary membrane. 



II. CEREBRAL ARTERIES. 



§ 1362. After giving off the ophthalmic artery, the internal carotid 
artery is distributed entirely to the cerebrum, particularly to its anterior 
portion, the posterior being supplied with blood from the vertebral 
artery. It, properly deserves then to be called, from this point, the 
anterior cerebral artery {A. cerebralis anterior). 

§ 1363. It gives off, first, small ramuscules, which go inward, and 
are designed for the posterior part of the optic nerve, for the infundi- 
bulum, for the pituitary gland, and for the third ventricle. 

§ 1364. It then gives off four branches ; these are the communicating 
artery, the choroid artery, the anterior cerebral artery, and the artery 
of the corptis callosum. The first two generally arise directly after each 
other ; and the carotid artery bifurcates farther on to give rise to the 
last two. Sometimes; but more rarely, three or all of these branches 
arise from the same point. 

§ 1365. The first, or the posterior communicating artery {A. com- 
municans posterior), goes backward and inward. It approaches that 
of the opposite side, opens into the posterior cerebral, which comes from 
the vertebral, artery, or if we prefer it anastomoses with a branch 
analogous to it, which ii meets 



ANGEIOLOGY. 251 

This anastomosis gives rise to the posterior part of the circle of 
Willis (circuhis Willissii). 

The size of this communicating artery varies extremely. It is gene- 
rally considerable, and only about one half smaller than one of the 
succeeding branches, into which the internal carotid artery divides. It 
is sometimes however very small; in this case the anastomosis 
between the internal carotid and the vertebral artery, frequently but 
not always takes place by means of another and larger branch of the 
anterior cerebral artery, which opens more outward into the posterior. 
The communicating artery is sometimes larger on one side than on the 
other. 

Sometimes this artery is a branch of the anterior cerebral.(l) It 
arises more rarely not from this but directly from the basilar artery, 
when the posterior cerebral artery does not come from it. and it is given 
off by the internal carotid. 

But the anastomosis almost always exists , and it is constantly sim- 
ple or at most double, on each side, when it occurs by considerable 
branches, although we find others which are accessory and smaller in 
the cerebral peduncles. 

We consider its total absence as one of the rarest anomalies. We 
have never yet seen it, and Barclay alone mentions one case where 
the injection penetrated neither from the carotid into the vertebral 
artery, nor from the vertebral into the carotid. (2) 

Several vessels arise from the communicating artery and go to the 
pia-mater or to the floor of the third ventricle, to the mamillary emi- 
nences, to the posterior part of the optic nerves, to the thalami optici, 
to the cerebral peduncles, to the inner face of the anterior part of the 
large cerebral lobe, and to the choroid plexuses. 

§ 1366. 6. Above the communicating artery, the internal carotid 
always gives off a special branch, the choroid artery (A. choroidta) 
which also arises from its posterior part. (3) This artery goes a little 
backward and outward, along the posterior edge of the origin of the 
optic nerve, ascends above the upper part of the cerebral peduncle, and 
expands partly in the pia-mater of the anterior part of the posterior 

(1) This anomaly, however, is proportionally very rare. Portal then estimates in- 
correctly, the relation between the rule and the exception, in saying that the internal 
carotid artery usually divides into two branches, the smaller of which is the artery of 
the corpus callosum, the larger the anterior lobate artery; the latter giving 1 off the 
communicating artery, which sometimes arises directly from the internal carotid. 
Hilderbrandt seem3 to think that the two cases are equally frequent, which is just as 
fabe. 

(2) hoc. cit., p. 47. 

(3) We have always found this branch very constant, although several anatomists 
particularly Mayer, Murray, Portal, Hilderbrandt, and Scemmcrring, do not mention 
it. Haller states ( Ic. anat., vol. vii. p. 5) that it sometimes exists. Sabatier, Boyer, and 
Bichat assert that is constant, which agrees with our remark. But Bichat errs in saying 
thatthechoroid is always smaller than the communicating artery. This case frequently . 
occurs, since, as we have observed, the communicating artery is usually large ; but 
we have often found, when this was small, that the choroid artery was as large or 
even larger than it. 



252 DES< itii'Tivr '.Nvii.in 

cerebral lobe and of the thalami optioi, and parUy also penetrates 
through the anterior opening of the lateral ventricle, into this cavity, 
where its ramifications expand in the choroid plexus. 

§ 13G7. The internal carotid now divides, at a very obtuse angle 
and at the anterior extremity of the fissure of Sylvius, into two unequal 
branches ; these are the artery of the corpus callosum and the anterior 
cerebral artery, 

§ 136S. The artery of the corpus callosum (A. callosa, s. corporis 
callosi, s. anterior cerebrica, s. anterior hemisphozri, s. mesolobica) is 
always smaller than the posterior branch. It goes forward and inward, 
directly before the union of the optic nerves, proceeds to meet that of the 
opposite side, towards which it converges very much, and after giving 
off superiorly generally several ramuscules for the posterior extremity 
of the anterior lobe, for the olfactory and for the optic nerves, it anas- 
tomoses with it between the posterior extremities of the first two lobea 
by the anterior communicating artery {A. anterior communicans, s. 
anostmnotica). This branch is generally very short ; sometimes how- 
ever, it is three or four lines long ; it is generally much larger in the 
former case and often very narrow in the second. Its direction is 
always transverse. Sometimes it is entirely double ; and we not 
unfrequently find it double in one half its extent.(l) It gives off, par- 
ticularly when longer than usual, ramuscules, which go upward and 
backward, into the septum lucidum, the fornix, and the corpus callo- 
sum. 

The trunk also generally sends off one or more small branches 
which proceed forward and outward to the inner part of the inferior 
face of the anterior lobe of the cerebrum. After this, it is situated 
directly near that of the opposite side, turns on the anterior extremity 
of the corpus callosum, ascends to the inner face of the cerebral hemis- 
pheres, and divides info several branches, the anterior of which enter 
into the circumvolutions of this internal face, while the posterior pro- 
ceed on the corpus callosum, as far as its posterior extremity, where 
they begin to change their direction and to go upward. All these 
branches extend to the upper face of the cerebrum and anastomose 
with those of the succeeding artery, and with those of the posterior 
cerebral artery, given off by the vertebral artery. 

Besides these large branches, into which the artery of the corpus 
callosum divides above, it also gives off, from its lower and concave 
part, numerous smaller branches, whtch distribute themselves in the 
corpus callosum. 

Rarelv, a large posterior branch is detached on both sides at the 
place where the two arteries of the corpus callosum meet, and 
the anterior anastomosing branch becomes the single trunk of the 
anterior part of the artery of the corpus callosum, which shortly divides 
into two large branches, a right and a left, or the two arteries arise 

(l) Bichat is incorrect in stating that this arrangement is very rare. 



ANGEIOLOGY. 253 

from a common trunk, and do not give off a branch posteriorly/' This 
arrangement is remarkable because of the analogy it establishes with 
the union of the two vertebral arteries into one, the basilar, which is 
situated on the median line. 

§ 1369. The anterior or more properly the middle cerebral artery 
(A. cerebri anterior, s. media, s. hemisphccrica media, s.fosscc Sylvii, s. 
sylviana), the last and the most posterior branch of the internal carotid, 
is always much larger than the preceding. Soon after its origin it 
goes outward, and only a little inward ; it enters the fissure of Sylvius, 
gives off, at its upper and posterior part, numerous, generally small, 
ramuscules, some of which penetrate into the anterior extremity of the 
posterior lobe, others into the posterior extremity of the anterior lobe, 
and afterward divides generally about half an inch from its origin into 
two, three, or four large branches. The largest of the latter are turned 
backward, soon bifurcate, and proceed, closely against each other, into 
the bottom of the fissure of Sylvius, where they go upward and back- 
ward. The anterior attain the posterior and external part of the ante- 
rior lobe, and the posterior the anterior central part of the posterior lobe, 
gliding in the circumvolutions of the posterior face of the first and the 
anterior face of the second, but penetrating mostly into their substance, 
through their outer face, and thus extend to the upper edges of the 
hemispheres, where they anastomose with the ascending branches of 
the anterior and posterior cerebral arteries. 

§ 1370. The anterior and middle cerebral arteries are not always 
arranged symmetrically. The two large middle arteries not unfre- 
quently arise (as Haller states and as we have verified) from the right 
carotid only, and the anterior, which is smaller, from the left carotid, 
an arrangement which deserves to be remarked as indicating the pre- 
dominance of the right side over the left. 

Sometimes also only the left anterior artery comes from the internal 
carotid of the same side, and the other three come from the right. We 
have seen this anomaly in several subjects. 

If we add the union of the arteries of the corpus callosum at their 
origin, which we mentioned above, we here find a remarkable repeti- 
tion of several of the varieties to which the origins of the trunks coming 
from the arch of the aorta are subject. 



ARTICLE FOURTH. 

ARTERIES OF THE UPPER EXTREMITIES. 

§ 1371. The arteries of the upper extremities, for which we cannot 
find a better term than that of the brachial arteries(l) {A. brachiales), 

(1) This term is generally applied only to that portion of the artery which corres- 
ponds to the arm, and which might more properly be termed the humeral 
artery. 



254 DESCRIPTIVE ANATOMY. 

arise on each side by a single trunk, generally called the subclavian 
artery (A. subclavia). 

I. SUBCLAVIAN ARTERY. 

§ 1372. The two subclavian arteries (A. subclavia) arise from the 
ascending aorta, and extend to the scaleni muscles. They differ in 
their mode of origin ; for the left subclavian artery arises directly from 
the arch of the aorta, while the right proceeds indirectly from it, as it is 
the external branch of the trunk of the innominata (truncus communis 
innominatus), which bifurcates and gives origin to it and to the right 
primitive carotid. 

This at least is the most common arrangement. Sometimes, but 
rarely, the subclavian arteries arise directly from the arch of the aorta. 
We may there find two principal differences. Sometimes in fact the 
trunk of the innominata gives off the right subclavian and the carotid, 
the subclavian artery arising on the right, outside of the carotid, which 
is the least but also the rarest anomaly. Sometimes the right sub- 
clavian artery arises more to the left, until it is the extreme left trunk 
of those which arise from the arch of the aorta, below the left subcla- 
vian artery, and goes to the right, towards the corresponding limb, 
passing behind the other trunks, rarely directly, more frequently be- 
tween the trachea and the esophagus, and still more frequently between 
the esophagus and the vertebral column. 

§ 1373. The first branches of the subclavian artery are never con- 
stant. They often and in fact almost always arise from its upper ex- 
tremity, directly before its passage between the scaleni muscles. But 
sometimes the artery gives off much sooner, and even near its origin, 
considerable branches, which go to the thymus gland, to the upper 
part of the pericardium, also to the trachea, to the bronchiae, and to the 
esophagus (Jl. thymic oe, pericardiacas superior, anterior et posterior, 
bronchicoz, oesophageal, broncho-ccsophagem), but they rarely or never 
belong to these parts alone, although they distribute branches to all. 
Even when these branches arise from the subclavian artery (which 
occurs on the left side more frequently than on the right, because it 
descends deeper) its course is no shorter, but it gives off no branch 
until just before passing between the scaleni muscles. Here, however, 
several large branches arise from it. These may be distinguished 
generally speaking into the upper or posterior and the lower or ante- 
rior branches; and Ihey vary much, for, 1st, the same twigs do not 
always arise from the same branches, so that the latter are not always 
of the same caliber ; 2d, small branches sometimes arise from the 
subclavian artery, by a common trunk, whence their number varies ; 
3d, they do not always emerge from the same point of the subclavian 
artery, the inferior arising sometimes farther forward, and the superior 
farther backward than usual. 



ANGEIOLOGY. 255 



A. UPPER POSTERIOR BRANCHES. 

§ 1374. The most constant of the upper and posterior branches are 
two, the vertebral artery and the inferior thyroid artery. 

I. VERTEBRAL ARTERY. 

§ 1375. The vertebral artery {A. vertebralis) is generally the first 
and largest of the two upper branches of the subclavian artery. Shortly 
after arising, it enters the arterial canal of the cervical vertebrae, and 
goes from below upward. This artery shows a great disposition to 
change its origin, and to arise directly from the arch of the aorta. We 
shall remark, 1st, that this anomaly, however common it may be, is 
seldom seen on the right side (at least to our knowledge), and that it 
rests always on the left ;(1) 2d, that when it occurs, the vertebral 
artery is almost always inserted between the left carotid and the left 
subclavian arteries. If this branch arises directly from the arch of the 
aorta more frequently than the others, it may be attributed, we think, 
to the following facts : 1st, in the normal state it is the first branch of 
of the subclavian artery ; 2d, the vertebral vein normally empties itself 
into the common trunk 01 the subclavian and jugular veins. The 
other fact, that the anomaly appears almost entirely on the left side, 
seems to us to depend on this, that the division of the trunk into 
branches characterizes the left side of the ascending aorta even in the 
normal state, since the subclavian arteries there arise separately, and 
are not blended in a single trunk, as on the right side. The greater 
length of the left trunk of the innominata vein may contribute to it, 
since this anomaly should be considered, as we have remarked, an 
imitation of the arrangement of the venous system. Finally, the situ- 
ation of this artery between the left carotid and the left subclavian 
arteries probably depends on its arising, in the normal state, from the 
internal and posterior side of the subclavian artery. 

We sometimes but rarely find on the right side a similar anomaly 
where the vertebral artery arises from the bifurcation of the trunk of 
the innominata ; this is still more curious, because in comparing this 
arrangement with that on the left side we have a new proof that the 
anomaly does not destroy in the two sides the character of the normal 
type. 

We know of only one case where the right vertebral artery arose 
from the arch of the aorta ; but that of the left side also presented the 
same anomaly. 

(1) This might be easily proved by numerous quotation*. Of all the authors who 
mention this variety Mayer is the only one who asserts the contrary; for, without 
speaking of the left vertebral artery, he asserts only that the right sometimes arises 
directly from the arch of the aorta. This assertion is so contradictory to observa- 
tion that it can be explained only by considering it as a typographical error. 



256 DESCRIPTIVE ANATOMY. 

A second anomaly of the vertebral artery consists in its division into 
several trunks. Sometimes then one of the trunks arises directly from 
the arch of the aorta ; the other, which is generally smaller, from its 
usual place ;(1) or both come from the subclavian artery, at a greater 
or less distance from each other. Perhaps the first arrangement also 
is found only on the left side ; at least in a specimen before us, and 
where the anomaly exists on the right, the two vertebral arteries are 
branches of the subclavian artery. In both cases one of the trunks, 
particularly the largest, enters the vertebral canal higher than usual. 
Sometimes it unites with the other, which enters at the normal place ; 
sometimes it unites with it before entering this canal; sometimes, finally, 
the smallest branch extends into the vertebral canal after passing over 
one or more vertebral foramina. 

Even when the vertebral artery is normal in respect to its origin, it 
enters the vertebral canal at several different points. Its proper place 
is the vertebral foramen of the sixth cervical vertebra. (2) 

In extremely rare cases this artery enters through the vertebral 
foramen of the seventh cervical vertebra. (3) Even when it arises lower 
than usual, from the arch of the aorta it however enters into the hole 
of the sixth cervical vertebra, and we have frequently seen it in this 
case not enter the vertebral canal until it reaches the fifth vertebra. 

More frequently, although not very often, the vertebral artery, even if 
not double, enters through the vertebral foramen of the fifth, fourth, third, 
or even the second cervical vertebra. We know of no case in which it 
has been found entirely out of the vertebral canal, and we have never 
known it to leave this channel lower than the upper vertebra, or to 
leave a vertebra, pass through a certain extent on the anterior face of 
the transverse processes, and enter again into the vertebral canal. 

Finally, the vertebral artery of one side is very frequently much 
larger than that of the other, although according to our observations 
the sides of the body have no effect on this disproportion. 

This anomaly confirms the general rule that the synonymous arteries 
which go to the single organs on the median line of the body often 
differ in volume and enlarge on one side at the expense of the other. 

(1) Henkol, Anmerkungen von weidernaturlichen Geburten, zweite Sammlung, 
p. 10, 11.— Hulier, De arcus aortee ramis ; in the Act. Helv., vol. viii. p. 68-102. 

(2) We have always observed this, except in a very few instances. Haller (Ic. 
anat.fasc. ii., e.rplic. icon. 2, art. thyr. infer., not. c) and Scemmerring (p. 177) are 
then correct in saying that this arrangement is normal. Mayer mistakes in saying 
(p. 110) that there is for the vertebral artery a special opening, through which it en- 
ters into the vertebral canal, sometimes in the seventh and sometimes only in the 
sixth cervical vertebra. This opening always exists except in a very few instances 
in the seventh cervical vertebra; but the vertebral artery rarely or never passes 
through it and always enters through the sixth. What Mayer considers the normal 
state is a rare anomaly, and vice versa. Monro (Outlines, df~c, vol. iii, p. 301) is also 
mistaken in thinking that the artery enters through the seventh cervical vertebra as 
often as it does through the sixth. 

(3) Bichat (p. 193) is correct in saying that it sometimes but rarely enters through 
a similar foramen of the seventh cervical vertebra. This arrangement is rare, as 
Haller, Murray, and Scemmerring' have not spoken^of it, although they mention the 
next. 



ANGEIOLOGY. 257 

§ 1376. The vertebral artery ascends in an almost straight line to the 
second cervical vertebra ; but at this point it becomes tortuous and de- 
scribes several curves, four of which are very remarkable. First, it 
penetrates into that part of the canal which belongs to the transverse 
process of the second vertebra, forming a right angle, assuming an en- 
tirely horizontal direction, and going transversely outward ; then pass- 
ing through this opening, it describes another right, acute, or obtusa 
angle, resumes its first direction, and becomes perpendicular again at 
the upper cervical vertebra. When it has passed through the vertebral 
foramen it inclines again at a right angle, resumes a second time a 
horizontal direction, and goes backward and inward, turning around 
en the articular process of the first eervical vertebra, along its posterior 
groove. From the posterior extremity of the articular process it goes 
gradually and at an obtuse angle inward and upward, and soon enters 
the cranium, passing through the dura mater and the large occipital 
foramen directly above the occipital condyle. Having entered the 
skull, it is situated first on the side, then on the lower face of the me- 
dulla oblongata, and ascends forward and inward on the basilar pro- 
cess of the occipital bone. There the two arteries approach each other, 
and after passing usually more than an inch within the cavity of the 
skull, they unite at an acute angle, either a short distance behind the 
posterior edge of the pons Varolii, or on this edge, or even in its centre. 
They always, as far as we know, unite and give origin to a single 
trunk, the basilar artery (A. basilaris), which is much smaller than the 
two branches which produce it. In size it nearly equals the interna! 
carotid artery after it gives off the ophthalmic artery. It proceeds for- 
ward to the centre of the lower face of the pons Varolii, and divides at 
its anterior extremity into two large branches, a right and a left. 

§ 1377. In this course the vertebral artery generally gives off no 
branches, or at loast but small and inconstant ones. These branches 
are distributed to the anterior deep muscles of the neck. In this 
respect the vertebral artery resembles the internal carotid. 

§ 1378. From the portion within the vertebral canal several small 
branches pass forward, outward, and backward, generally between 
every two vertebrae, and go to the vertebrae, to the intertransversarii, 
to the multifidus spinae, to the anterior deep muscles of the neck, and 
to the small muscles of the head. 

Internal branches, which are also very small, pass through the intern- 
vertebral foramina, either alone or attended with small arterial twigs 
from the other branches of the subclavian artery, penetrate the verte- 
bral canal and are distributed partly to the nerves, others to the anterior 
and posterior sides of the dura mater and to the pia mater of the spina! 
marrow. They anastomose with those of the opposite side and with 
the anterior and posterior spinal arteries. 

Considerable branches arise from that part of the vertebral artdry 
between the first ami the second cervical vertebrae, and also between tho 

Vol. II 3*3 



I5ti 



descriptive anatomi 



latier and the occipital bone. Some go outward, are expanded in the 
transversalis colli and the complexus minor muscles, and anastomose 
with the branches of the ascending cervical artery, and sometimes en- 
tirely replace it. The others proceed backward and outward and are 
distributed in the posterior and lateral small muscles of the head. Some 
go inward and anastomose with the synonymous branches of the other 
side. Finally, many enter the tissue of the dura mater. 

§ 1379. The largest branches arise from that part of the vertebral 
artery within the skull. From the difference of caliber between the 
branches which it sends out of the cavity of the skull, this part is fre- 
quently much larger on one side than on the other, although both have 
primarily the same diameter at their origin and although the side of the 
body has no necessary influence upon this difference. 

The branches which arise before the two vertebral arteries unite are 
the anterior spinal artery, the posterior spinal artery, and the inferior 
artery of the cerebellum. 

§ 1380. The posterior spinal artery (A. spinalis posterior) is the 
smallest, and often comes from the inferior artery of the cerebellum. It 
arises the lowest and from the outside of the vertebral artery, goes 
inward on the posterior face of the spinal marrow, and descends on each 
side along the posterior spinal groove to the end of the spinal marrow. 
The two arteries are very tortuous and are parallel to each other. They 
are always enlarged by the accessory ramuscles of the vertebral, the 
deep cervical, and the intercostal arteries which pass through the inter- 
vertebral foramina, and anastomose by numerous transverse branches, 
which generally correspond to the intervertebral spaces ; so that each 
portion of the spinal marrow between two vertebra has its special vas- 
cular circle, even as the four cerebral arteries form one by their anas- 
tomoses. 

§ 1381. The inferior artery of the cerebellum {A. inferior cerebelli) 
also arises from the outer side of the vertebral artery and is usually 
double on both sides. 

One, the posterior inferior artery of the cerebellum, arises farther 
backward, and goes backward, upward, and inward, proceeds on the 
lateral parts of the medulla oblongata, distributes its branches to the 
tela choroidea of the cerebellum and to the floor of the fourth ventricle, 
and ascends between its two hemispheres to its vermiform eminence 
and to the inner face of its two hemispheres. This branch often exists 
on one side only, and then it is observed particularly when the inferior 
artery of the cerebellum arises very far forward. 

The anterior inferior artery of the cerebellum sometimes arises 
at the origin, sometimes also at the extremity of that portion of the 
vertebral artery within the skull. In some subjects, particularly when 
the vertebral arteries unite early, it comes from the basilar artery. These 
varieties are observed even on both sides of the body at once. The 
anterior inferior artery of the cerebellum not only frequently exists 
alone but it is generally much larger than the posterior. It is some- 



a.ngeiclom 2a9 

times much smaller on one side than on the other. It proceeds very 
tortuously outward and backward to the lower face of the cerebellum, 
where itjpasses on the grooves which it crosses and divides into branches, 
some of which go backward and others forward. These branches also 
cross the direction of the grooves of the cerebellum ; the small ramifr- 
cations alone become parallel and finally penetrate into them. 

§ 1382, The anterior spinal artery (A. spinalis anterior) generally 
commences a short distance from the lower edge of the pons Varolii, 
even when the two vertebral arteries unite much higher than usual. 
It arises from the internal part of the trunk and soon unites with that 
of the opposite side in a single trunk on the median line, which descends 
along the anterior groove of the spinal marrow. Generally, particularly 
when the two vertebral arteries unite higher than usual, we find a 
small anterior and superior spinal artery, which is sometimes single 
and arises from the top of the angle of union, and sometimes double, 
which blends likewise with that of the opposite side, and which, pro- 
ceeding also from above downward, soon anastomoses with the lower. 
The single trunk of the latter, which corresponds to the median line, 
is often divided in its course and thus forms considerable islands. Its 
upper part receives also from all or most of the intervertebral foramina, 
considerable branches, which are given off by the vertebral or the other 
cervical arteries to the anterior face of the spinal marrow and anasto- 
mose with it. During its course, which is very tortuous, it sends off 
on each side numerous branches to the spinal marrow. 

II. BASILAR ARTERY. 

§ 1383. The basilar artery (A. basilaris, s. meso-cephalica) is coi> 
stant, and arises, proceeds, and varies in the manner mentioned above. 
We however sometimes remark in its arrangement a tendency to a 
want of union or to the separation of the vertebral arteries, since it forms 
islands, especially at its posterior part. This artery is however the 
only one in which we have observed this arrangement. It very soon 
divides into two parts, which almost immediately unite. We consider 
this anomaly as very rare, not only because we have never seen it but 
twice, but because it is not mentioned by the most correct angeiolo- 
gists.(l) It is curious not only as an anomaly, but because it increases 
the analogy between the basilar and the anterior spinal arteries, which 
are already so similar. It is not unimportant to say, that in the two 
subjects which presented this unusual arrangement the anterior con> 
municating artery of the two internal carotids presented analogous 

(1) An arrangement has been figured by Heuermann (Physriologie, vol. ii. tab. 8) 
where the two vertebral arteries were connected behind their union by a large trans*- 
verse branch, to give rise to the basilar artery, which seems to have some relation 
with this anomaly ; but more probably it consisted only in the union of the anterior 
Fpinal arteries, since the two vertebrrrl arteries are not yet uni*wl behind rfli's br<Trttt» 



• 



260 DESCRIPTIVE ANATOMY. 

divisions. In the latter however this anomaly is much more common 
than in the'basilar artery. 

From both sides of the basilar artery numerous branches arise, gene- 
rally at right but sometimes at angles slightly acute, backward, which 
vary much in number and volume and do not correspond perfectly on 
both sides. The smallest enter into the pons Varolii and the nerves 
which come from it ; the largest, even when the usual inferior arteries 
of the cerebellum do not exist, proceed even to the lower face of the 
cerebellum. 

Some branches, the internal auditory arteries («#. auditivas interna), 
enter into the internal auditory foramen, expand in the labyrinth, and 
anastomose with the branches of the internal and of the external carotid 
arteries which enter into this organ. 

§ 1384. At its anterior extremity, in the middle of the anterior edge 
of the pons Varolii, the basilar artery usually divides into four branches, 
two on each side, the superior artery of the cerebellum and the poste- 
rior cerebral artery. 

§ 1385. The superior artery of the cerebellum (A. cerebelli superior) 
which is almost as large as the inferior, is rarely deficient on one side, 
in which case it is replaced by a branch of the following. It is more 
frequently double ; and then the vertebral artery divides into five 
branches, of which the two superior arteries of the cerebellum are situ- 
ated very near each other : sometimes but much more rarely, it arises 
some lines behind the anterior extremity of the vertebral artery. 
It goes transversely outward and upward, directly behind the anterior 
edge of the pons Varolii, then proceeds a little backward, turns upon 
the pons Varolii to arrive at the anterior edge of the cerebellum, 
and divides into superficial and deep branches. The first proceed 
backward on the ridge of the cerebellum to its posterior edge, where 
(hey anastomose with the branches of the inferior artery of the cere- 
bellum ; the others penetrate upward into the anterior lobes. 

§ 1386. The two anterior branches, the posterior or deep cerebral 
arteries, Lobaires posterieures du cerveau, Ch. (A. cerebri posterior es, s. 
profunda}), are mcich larger than the superior arteries of the cerebellum. 
They arrive at an acute angle, separate much from each other, and go 
forward and outward. They usually give off near their origin and at 
their upper and external part several branches, some of which are con- 
siderable and go to the cerebral peduncles, to the thalami optici, to the 
tubercula quadrigemina, and to the valve of Vieussens. After proceed- 
ing a short distance they divide into two branches, the communicating 
artery and the continuation of the trunk. 

The communicating artery is situated inward, and is smaller than 
the other. Its direction is outward and forward and it proceeds to meet 
the anastomosing branch of the internal carotid artery, with which it 
unites. 

The continuation of the trunk of the posterior cerebral artery, which 
is usually the smallest of the three proper cerebral arteries, sometimes 



ANGE.OLOGY. 261 

anscs from the internal carotid artery, previous to its bifurcation, and 
sometimes also from the union of the anastomosing branches given off 
by the internal carotid and the vertebral arteries. It goes outward and 
upward, before the third pair of the cerebral nerves, and turns on the 
cerebral peduncle, to the lower face of which it gives some ramuscules, 
which thus arrive at the thalami optici and the tubercula quadrige- 
mina, penetrate into the third ventricle, and are distributed principally 
to the choroid plexus. Finally, it goes on one side to the posterior part 
of the cerebrum and of the corpus callosum, and also to the thalami 
optici on the other, particularly to the lower face of the cerebral hemi- 
spheres. It anastomoses very frequently with the anterior or central 
arteries and with the arteries of the corpus callosum, which arise from 
the internal carotid artery. 

§ 1387. The peculiarities presented by the arteries of the brain have 
been described before or will be mentioned when we speak of the enceph- 
alon. 

II. INFERIOR THYROID ARTERY. 

§ 1388. The inferior thyroid artery {A. thyroidea inferior, s. sacro- 
thyroidea, Barclay) arises from the subclavian artery, more outward 
and forward than the vertebral artery, from which however it is not 
always the same distance. It most generally gives off the inferior 
thyroid branch and several twigs, -which go to the muscles and to the 
skin of the neck, the back, and the shoulder. 

This artery is large, particularly in the child, where it is equal to 
the subclavian or even the carotid artery. Its size however varies 
much, because that one or more branches which it commonly furnishes 
frequently arise from other trunks, but the arteries which generally 
come directly from the subclavian artery are rarely given off by it. 
This is true for instance of the internal mammary artery, and the former 
is true in regard to the branches which go to the muscles of the neck, 
shoulder, and back. Sometimes it goes only to the thyroid gland. In 
other cases it is uncommonly large, because it gives off not only the 
usual branches but also the internal mammary artery. In rare cases 
on the contrary, it does not deserve its name, because it gives branches 
only to the muscles and the inferior thyroid arises from the common 
carotid artery, or does not exist as a separate vessel, but is blended 
with the superior thyroid artery. This anomaly is curious, as it is a 
repetition of the normal formation of most mammalia. 

Another and somewhat similar anomaly is when the inferior thyroid 
artery is uncommonly small, either on one or both sides, and one or 
both of the superior thyroid arteries are larger in the same proportion, 
or finally when beside the two common thyroid arteries, there is also a 
third (A. thyroidea ima, s. Neubaueri), which arises lower down either 
from the arch of the aorta on the right of the left carotid or from the 
crrramon trunk of the carotid and the subclavian artery, when the 



2.62 UES'CRIPTIVE ASATOMi 

anomaly occurs on the right side, or from the common trunk of the 
carotids of one side only, or finally from both sides at once, sometimes 
higher and sometimes lower. 

We must also mention here the rare anomaly where the inferior 
thyroid artery is totally deficient on one side, while on the other, in 
the usual place, particularly on the right, instead of the two inferior 
thyroid arteries, we have a common trunk,(l) which arises sometimes 
from the aorta and sometimes from its usual place. We have twice 
observed a case resembling this, where the inferior thyroid artery arose 
from the arch of the aorta, between the trunk of the innominata and 
the left carotid arteries. 

III. SUPERIOR SCAPULAR ARTERY. 

§ 1389. In most cases the inferior thyroid artery, immediately after 
arising, give3 off the superior scapular artery (R. transversus scapula, 
a. scapularis transversa, s. scapularis superior, s. cervicalis superjicialis), 
which however sometimes arises from the subclavian artery, sometimes 
singly, and sometimes by a common trunk with the following. It goes 
transversely backward and outward behind, and a little above the cla- 
vicle between the scalenus anticus and the scalenus medius ; gives 
branches to the sterno-thyroideus,the sterno-hyoideus, the omohyoideus, 
the scaleni, the trapezius, and the supraspinatus muscles ; passes be- 
tween the spine and the glenoid cavity of the scapula, and enters the 
infraspinalis fossa. There it divides into several branches, the smallest 
of which usually pass through the semicircular notch to the anterior 
face of the scapula and to the subscapularis muscle, while the largest 
are distributed on the posterior face of this bone, to which it gives one 
or more nutritious twigs, and terminates in the infraspinatus muscle. 
Another branch arises from this point and goes forward between the 
proper and common ligaments of the scapula, distributes itself in the 
articular capsule of the shoulder and to the upper and anteriorjmrt of 
the deltoides muscle, and anastomoses by several large branches with 
the anterior circumflex artery of the arm and with the great thoracic 
artery. 

IV. TRANSVERSE CERVICAL ARTERY. 

§ 1390. The transverse cervical artery (Jl. cervicalis superjicialis, s. 
cervicalis transversa, s. colli transversa), which is generally as large as 
the preceding, arises from the inferior thyroid artery, a little higher and 
at some distance from it outwardly ; it often arises directly from the 
subclavian artery. It goes transversely outward and backward. It is 
situated at first on the side of and a little behind the superior capsular 
artery, and it gives off in this course branches to the scaleni muscles. 

(1) Burns, loc. tit., p. 331. 



ANGEIOLOGY. 263 

and divides into two large branches on a level with the upper edge of 
the shoulder. The ascending branch becomes the principal branch of 
the trapezius and also sends some ramuscules to the levator sca- 
pulae muscle ; the other descends along the base of the scapula, between 
the rhomboidei and the serratus magnus muscles, in which course it 
gives off twigs to these muscles and also to the lower part of the tra- 
pezius muscle. 

§ 1391. A little higher, one or more small branches (R. thoracici) 
arise very constantly from the inside of the inferior thyroid artery ; these 
go upward and inward to the lower part of the longus colli muscle, 
penetrate also the spinal canal through the intervertebral foramina, but 
go particularly to the trachea and to the esophagus. The latter are 
termed the bronchial and the esophageal arteries (A. branchiales, ttsO' 
fthageai, s. broncho-ORSophageaz). 

§ 1392. After passing through rather a long course upward without 
giving off any branch, the inferior thyroid artery divides into two 
branches, the ascending cervical artery, which is generally much 
smaller and goes upward and outward, and the thyroid artery, which 
may be considered as the proper continuation of the trunk. 

V. ASCENDING CERVICAL ABTETY. 

§ 1393. The ascending cervical or the superior dorsal artery (jj. 
cervicalis ascendens, s. dorsalis suprema) is a very constant branch of 
the inferior thyroid artery and sometimes but rarely arises from the 
subclavian artery ; this happens particularly when the branches already 
described arise separately from the proper thyroid artery. Sometimes 
also it arises from the internal mammary artery. It ascends along the 
transverse processes of the cervical vertebrae, between the longus colli 
and the scaleni muscles. In its course it gives off backward, outward, 
and upward several considerable branches, which are distributed in the 
upper part of the trapezius, the levator scapulas, the serratus magnus, 
the serratus posticus, the scaleni, and the splenii muscles, and the skin 
of the neck : the trunk generally goes backward, below the transverse 
process of the third cervical vertebra, penetrates deeply between the 
transversalis colli and the complexus minor muscles, and having 
thus come upon the posterior face of the neck, it terminates in two 
principal branches ; the smaller ascends behind the transverse pro- 
cesses of the cervical vertebrae, gives ramuscules to the complexus 
minor muscle and to the posterior small muscles of the head, anasto- 
moses with the vertebral and occipital arteries, and finally penetrates 
into the spinal canal between the first and second cervical vertebrae, 
where it terminates in the dura mater. The other is larger and is the 
continuation of the trunk : it goes outward between the fasciculi of the 
complexus major muscle, and terminates in this muscle and in the 
digastricus and the posterior muscles of the heart 



264 DESCRIPTIVE ANATOMY. 

§ 1394. The thyroid branch {R. thyroidens) sometimes arises singly 
from the subclavian artery, from the aorta, the innominata, or from the 
common carotid artery. It is sometimes entirely deficient in some sub- 
jects, but is generally the largest branch of the inferior thyroid artery. 
It is very tortuous and curves very much in ascending toward the 
thyroid gland. It usually passes behind, sometimes but rarely before, 
the primitive carotid, in order to arrive at this gland. Before reaching 
it, it divides into several branches, which enter this organ principally 
on its lower edge and lower face and anastomose with each other and 
with those of the superior thyroid artery. 

The thyroid branch also gives in its course smaller ramuscules to 
the longus colli muscle, to the pharynx, and particularly to the larynx. 
The latter is termed the inferior laryngeal artery (Jl. laryngea inferior). 

VI. LOWEST THYROID ABTEEY. 

§ 1395. Besides the branch described (§ 1364), another branch called 
the lotvest thyroid artery (Jl. thyroidea ima) arises, sometimes from the 
primitive carotid or from the innominata, from the arch of the aorta or 
from the subclavian artery, by a trunk in common with that of the op- 
posite side. 

This anomaly occurs on the right side more frequently than on the 
left ; ( 1 ) we have never observed it on the latter side, although we 
have frequently seen it on the other. In one case only, where the 
origin of the inferior thyroid artery was abnormal, it did not arise from 
the left side of the arch of the aorta, but from the right side, between 
the innominata and the left carotid artery ; thence it passed before the 
trachea to go to the left side of the thyroid gland, while the origin and 
direction of the right was normal. This anomaly then seems properly 
to belong to the right side, even as the similar anomaly of the vertebral 
artery appears exclusively on the left side. 

Finally, whether this abnormal artery forms a part or the whole of 
the inferior thyroid artery, whether it arises from the innominata, or 
from the arch of the aorta, or deeply from the primitive carotid artery, 
it always passes on the anterior face of the trachea to go to the thyroid 
gland, into which it enters from below upward. It cannot then escape 
being wounded in the operation of laryngotomy. 

(1) We have found it nine times on the right. Hubert (loc. cit., p. 84) has seen the 
lowest thyroid artery arise four times from the common trunk, three times on the 
right and only once on the left side. Neubauer has also seen the right coming from 
the aorta (in Erdmann, Descrip. art. thyr. imoc, Jena, 1772). Ramsay (Account of an 
unusual conformation of some muscles and vessels, in the Edinb. Med. and Surg. 
Journ., vol. viii. p. 281-283, tab. 1, fig. 2) has found it arising from the innominata 
trunk. Loder has twice seen it arising from the aorta, between the right carotid and 
the subclavian arteries : the innominata trunk did not exist in these two cases (Dc 
n-onnullis arteriarum varietatibus, Jenaj 1781). 



ANGEIOLOGY. 265 



VII. DEEP CERVICAL ARTERY. 



§ 1396. The deep cervical artery (A. cervicalis profunda) often forms 
a special trunk, which arises from the back side of the subclavian artery, 
a little more externally than the preceding, but frequently by a common 
trunk with the superior intercostal artery. It is rarely given off by 
the inferior thyroid or even by the vertebral artery ; in the latter case 
its origin is generally a little below that of the vertebral artery. It more 
rarely comes from the upper part of the latter, in which case it some- 
times descends between the first cervical vertebra and the occipital 
bone, and is afterwards distributed as usual, but so that its lower 
branches are almost always supplied by the other branches of the sub- 
clavian artery. 

It goes obliquely upward and outward, passes backward between 
the transverse processes of the sixth and seventh cervical vertebrae or 
the latter and the first dorsal vertebra. It ascends between the trans- 
versalis colli, the spinalis colli, and the semispinalis dorsi muscles 
on one side, and the digastricus and the complexus muscles on the 
other. It also distributes branches to the scaleni, the complexus minor, 
the cervicalis descendens, the trapezius, the splenii, and the small pos- 
terior muscles of the head, and anastomoses, especially above, near the 
occipital foramen, with the branches of the vertebral and occipital arte- 
ries. It also sends ramuscules into the spinal canal through the inter- 
vertebral foramina, which anastomose there with the spinal arteries 
given off by the vertebral artery. 



B. INFERIOR BRANCHES. 



§ 1397. The inferior branches of the subclavian artery are the inter- 
nal mammary artery and the superior intercostal artery. 



I. INTERNAL MAMMARY ARTERY. 



§ 1398. The internal mammary artery (A. mammana interna, s. 
sternalis, s. substernalis) is much smaller than the vertebral and the 
inferior thyroid arteries. It arises ordinarily and very constantly by a 
distinct trunk from the anterior or inferior side of the subclavian artery, 
nearly opposite the inferior thyroid artery. It however in some rare 
cases, one of which is now before us, arises by a common trunk with 
the latter, or on the right side from the innominata,(l) or even from 
the arch of the aorta. (2) 

It generally goes downward and inward, but sometimes also as- 
cends a little before taking this direction, which it long preserves. It 

(1) Neubauer, loc. cit., p. 33. 

(2) Boehmer, De quat. ct quinq. aortce ram.; in Haller, Collect, diss, anal., vol. ii. 
p. 452. 

Vol. II. 34 



266 



DESCRIPTIVE AJSATOMV. 



descends almost in a straight line to the posterior face of the anterior 
wall of the chest, on the costal cartilages between the intercostales and 
the triangularis sterni muscles, nearer its internal than its external ex- 
tremity, consequently not far from the two edges of the sternum, which 
it also approaches a little below. 

Besides several branches which go from its upper part to the lower 
part of the anterior muscles of the neck, it sometimes gives off a supe- 
rior bronchial artery, the thymic, and a branch which is distributed to 
the pericardium and also to the anterior mediastinum. But its upper part 
constantly gives off a branch which accompanies the diaphragmatic 
nerve, called the superior diaphragmatic artery (Jl. diaphragmatica 
superior, s. pericardio-diaphragmatica). This branch sends ramuscules 
to the pericardium, to the internal wall of the mediastinum, and to the 
esophagus, and expands in the anterior and middle portion of the dia- 
phragm, where it anastomoses with the inferior diaphragmatic artery. 

In its course along the sternum the internal mammary artery gives 
off external and internal branches. 

The external branches, the anterior intercostal arteries, (Jl. inter- 
costales anteriores), are usually larger and more numerous than the 
internal. Their number is not exactly the same in every part, but 
they equal in number the intercostal spaces, over which the internal 
mammary artery passes. They generally proceed along the lower, 
rarely along the upper edge of the ribs, and almost always in the latter 
case one intercostal space contains two of them. They go backward 
between the intercostales interni and externi muscles, and anastomose 
with the intercostal arteries given off by the descending aorta and with 
the thoracic arteries which arise from the axillary artery. 

One of these branches, the fifth, sixth, or seventh, has been called 
the musculo-diaphragmatic artery (Jl. musculo-phrenica) . It is usually 
very considerable, sometimes as large as the trunk, of which it seems 
even to be a continuation. It is distributed not only to the anterior 
part of the diaphragm but also it arrives at the upper part of the broad 
abdominal muscles, whence its name, where it anastomoses with the 
epigastric artery. 

The internal branches, which are smaller and fewer than the pre- 
ceding, go, some to the internal face of the sternum, others to the ante- 
rior face of the pericardium, and some, viz. the deepest, to the anterior 
part of the diaphragm ; finally, others leave the pectoral cavity through 
the intercostal spaces and are distributed in the upper part of the abdo- 
minal muscles. 

The trunk of the internal mammary artery commonly divides into 
two principal branches of different sizes, an external and an internal. 
This bifurcation occurs sometimes higher and sometimes lower, and 
occasionally it is seen opposite the anterior extremity of the fifth rib, 
and sometimes only opposite the eighth. 

The external branch goes obliquely outward, along the costal carti- 
lages, above the intercostal spaces. It terminates by the lowest of the 



ANGEIOLOGY. 267 

anterior intercostal arteries and by small branches which enter the 
anterior edge of the diaphragm and the upper part of the broad abdo- 
minal muscles. It is also called the superior epigastric artery («#. epi- 
gastric a superior). 

The internal branch proceeds perpendicularly downward, passes 
between the anterior and internal digitations of the diaphragm, and 
comes upon the posterior wall of the rectus abdominis muscle, where it 
soon divides into several branches, which descend vertically and anas- 
tomose as high as the umbilicus with the ascending branches of the 
epigastric artery and also with the ramifications of the external branch. 

II. SUPERIOR INTERCOSTAL ARTERY. 

§ 1399. The superior intercostal artery (.#. intercostalis suprema, s. 
prima) arises more externally than the preceding, and is given off from 
the posterior part of the subclavian artery. It is the smallest and the 
most external of the four constant branches of the latter, and varies in 
size. Sometimes it is very small ; in this case it arises almost always 
directly from the subclavian artery. It is rarely given off by the 
inferior thyroid artery, and it frequently arises by a common trunk 
with the deep cervical artery. 

The distribution of this artery varies very frequently, especially in 
regard to its extent. It however always goes downward and outward, 
passing on the neck, and gives upward and downward branches, of 
which the lower are much larger than the upper. 

The superior branches go to the transversalis colli muscle and send 
branches to the deep muscles of the back. 

The inferior, which are a continuation of the trunk, divide into ex- 
ternal and internal or posterior branches. 

The external or intercostal branches (R. interossei) proceed along the 
lower edge of the first and second ribs, between the intercostales interni 
and externi muscles. They generally do not extend very far forward 
and divide into two ramuscules, an upper and a lower, which follow, 
the former the lower edge of the upper rib and the second the upper 
edge of the lower rib, and are distributed in the posterior part of the 
intercostales muscles between Which they proceed, and anastomose be- 
fore with the superior anterior intercostal arteries (§ 1397). Sometimes 
we find two branches in the same intercostal space, one of which gives 
off two twigs. 

The posterior, internal or dorsal branches (R. dorsales) usually arise 
more or less opposite the external and divide like them into two ramus- 
cules, the internal of which is almost always larger than the other, and 
enters into the spinal canal through the intervertebral foramen, is dis- 
tributed to the spinal membranes and the spinal marrow, and anasto- 
moses with the spinal arteries which arise from the vertebral artery ; 
while the external, proceeding between the ribs goes backward, where 



268 DESCRIPTIVE ANATOMY 

it enters the deep muscles of the back, the multifidus spinae and the 
spinalis dor si. 

When the superior intercostal artery is very small, it is distributed 
only to the first intercostal space, but its branches generally extend to 
the second. 

It more rarely gives origin, as we have already said, to the deep 
cervical artery, and it also gives off very near its origin an esophageal 
or bronchial artery (Jl. ozsophagea et bronchialis), which varies in size 
and turns inward and forward, sending branches to the lower part of 
the trachea, also to the centre of the esophagus, and likewise gives them 
to the bodies of the upper dorsal vertebra?, and communicates by broad 
anastomosing branches with the other esophageal and bronchial arteries. 

§ 1400. The subclavian artery gives off those branches only which 
we have described. Sometimes however it sends from its lower and 
anterior side a considerable branch to the lymphatic glands in the upper 
region of the chest. It also gives off above the lower extremity of the 
scalenus anticus others, which go outward to some of the axillary 
glands. 

§ 1401. The artery of the upper extremity then assumes a trans- 
verse direction, separates from the trunk, goes downward and outward 
between the scalenus medius and anticus, and is called the axillary 
artery. 

II. AXILLARY ARTERY. 

§ 1402. The axillary artery (Jl. axillaris) extends from the scaleni 
muscles to the lower extremity of the axilla. It is situated between 
the chest and the arm, its upper part being nearer the former, while its 
lower part approaches the latter because it proceeds obliquely down- 
ward and outward. For a short space its upper part is covered only 
by the skin and the platysma myoides muscle ; below we find the 
clavicle before it, as it passes behind its centre the subclavius muscle, 
and still lower the outer part of the pectorales muscles. Backward 
and outward we observe, above, the brachial plexus, then the subsca- 
pularis muscle, the scapulo-humeral articulation, and the tendon of the 
latissimus dorsi muscle. On its inside it has, above, the first two ribs, 
below, the serratus magnus muscle. 

It is imbedded in a very loose cellular tissue, and is surrounded by 
the axillary glands, and is attached but feebly to the adjacent parts, 
excepting a small portion of its upper part. As in this place it rests 
on the first and second ribs, it may easily be compressed whenever an 
operation near or within the scapulo-humeral articulation requires. 

§ 1403. Several branches, which are not very constant, arise from 
this artery. The principal, regarded from above downward, are the 
external thoracic arteries, the inferior scapular artery, and the circum- 
flex arteries. These branches vary in respect to volume, number, and 
origin, because sometimes many of them arise by a common trunk, and 



ANGEIOLOGY, 269 

again sometimes one or more come much lower than usual from the 
brachial artery, or finally in some cases by a trunk in common with the 
deep brachial artery. 

Besides these branches the axillary artery also gives off, in part or 
entirely, far outward above, one or more of the external thoracic arteries, 
the transverse scapular artery, so that the principal portion of this latter 
artery arises at its usual place, but its smallest branch distributes 
itself to the subscapularis muscle. This anomaly is very remarkable, 
because it gradually leads to another, which is much greater, where 
the transverse scapular artery is entirely deficient, or at least is very 
small ; so that the branches usually given to the muscles of the sca- 
pula come from the superficial scapular artery. 

I. EXTERNAL THORACIC ARTERIES. 

§ 1404. The external thoracic arteries (A. thoracicoz externa;, s, 
alares) vary in number from three to six. 

Some arise from the inside, others from the outside of the axillary 
artery. 

§ 1405. The former are usually smaller than the latter. They go 
principally to the superior external intercostal muscles, to the pectoralis 
minor muscle, to the axillary and thoracic glands, and go downward 
and forward even to the skin. Sometimes we find only one, and again 
there are two, which are then much smaller. One of these two arteries, 
and when there is only one, that one usually arises highest from the 
trunk of the axillary artery ; it is then termed the superior external 
thoracic artery (A. thoracica externa suprema, s. jjrima), and is also 
called the small external thoracic artery (A. thoracica externa minor), 
because it is always smaller than the others. 

§ 1406. The second external thoracic artery is rather constant and 
is called the acromial artery (A. acromialis). It arises from the outside 
of the axillary artery and is sometimes single and sometimes double. 
In the latter case, some of the branches usually given off by the single 
trunk generally arise very near each other, from the axillary artery. 

This artery gives off, first, upward and forward and upward and out- 
ward, small branches which go to the subclavius muscle ; second, others 
below, which go to the inner part of the upper edge of the deltoides 
muscle and also to the upper part of the capsular ligament of the shoul- 
der, where they anastomose below the acromion process with the 
branches of the superior scapular artery. 

Larger and more numerous branches arise forward, inward, and 
downward, above and below the pectoralis minor muscle ; they enter 
this muscle and also the pectoralis major muscle from within and 
without, and are distributed principally in them. 

Others, which pass on the pectoralis minor muscle, go outward and 
forward toward the anterior and internal edge of the deltoides muscle, 
intc which they penetrate from below upward, and extend to the cap- 
sular ligament of the scapulo-humeral articulation, on the surface of 



270 DESCRIPTIVE ANATOMT. 

which they anastomose with the preceding and also with the branches 
of the inferior scapular artery and the anterior circumflex artery. They 
penetrate also to the posterior muscles of the scapula and to the sub- 
scapularis muscle. 

A constant branch descends along the inner edge of the deltoides 
muscle, between it and the pectoralis major muscle, at the side of the 
cephalic vein. This branch is always considerably large, and it arises 
sometimes directly from the axillary artery, but then it comes below all 
the others from which it is very remote, and no longer proceeds between 
the deltoides and the pectoralis major muscles, but descends below the 
latter, between the coraco-brachialis and the two heads of the biceps 
flexor muscle, and gives off considerable branches to these two muscles. 

Other branches, which are still lower, go to the axillary glands, to 
the serratus magnus, and sometimes to the trapezius muscle. 

§ 1407. The third, or, when the first or the second or both are double, 
the fourth or the fifth external thoracic artery, the long thoracic, or the 
external mammary artery (J3. ihoracica externa longa, mammaria ex- 
terna) is given off so constantly by the subscapular artery that it should 
never be described as a separate artery. We shall mention it hereafter. 

§ 1408. Not unfrequently two branches, which arise from the sub- 
scapular artery, come directly from the axillary artery and form a third, 
fourth, or fifth external thoracic artery, which is distributed to the sub- 
scapularis muscle. 

II. SUBSCAPULAR ARTERY. 

§ 1409. The subscapular artery, the inferior or common scapular 
artery (A. subscapularis, scapularis inferior, infra-scapularis, scapularis 
communis) is generally the largest branch of the axillary artery and 
sometimes equals this trunk in size. It arises near its inferior extre- 
mity, at the lower edge of the tendon of the subscapularis muscle ; so 
that its origin is covered by the brachial plexus. It is rarely given off 
lower down. 

Its origin is very constant, and when it arises from the inferior thyroid 
artery it is one of the rarest anomalies, and occurs certainly only in 
regard to its upper part. 

The volume and number of its branches vary. In its greatest deve- 
lopment it gives off, first, the final external thoracic arteries, which we 
have already described, which are its first branches; and which go up- 
ward and backward and are distributed in the infraspinatus muscle ; 
2d and 3d, one or two circumflex arteries of the arm ; 4th, even the 
deep brachial artery in whole or in part ; 5th, the long external lateral 
thoracic artery (§ 1407), more rarely the second, third, and the fourth 
branches, usually the first and the fifth. 

After giving off the first subscapular branches, the artery proceeds 
inward and downward and divides into two branches, an inferior de- 
scending branch and a superior, which is larger, goes backward and is 



ANGEIOLOGY. 271 

the continuation of the trunk, and is called the circumflex artery of the 
scapula (A. circumflexa scapula,). 

The circumflex artery of the scapula, shortly after giving off the 
ascending branch, sends off several beside, some of which are large and 
others small, to the outer edge of the subscapularis muscle, to the teres 
minor and major muscles, to the axillary glands, the skin of the axilla 
and of the back, and to the subscapularis muscle. It afterwards curves 
around the neck of the scapula, passes on its posterior face, where it is 
called the dorsal artery of the scapula (A. dorsalis scapidoz), when it is 
very much developed, penetrates partly into the bone, and ascends 
partly also upward and inward into the subscapularis muscle, advances 
on the neck of the scapula, and anastomoses with the acromial and 
with the superior scapular arteries ; finally, when the latter is smaller 
or deficient, it re-ascends below the spine of the scapula into the supra- 
spinalis fossa, and distributes branches to the supraspinatus and like- 
wise to the trapezius muscle. 

When it is less developed it does not penetrate deeply between the 
scapula and the infraspinatus muscle, but only into the posterior part of 
the deltoides muscle, and anastomoses with the preceding arteries on 
the acromion process and on the anterior edge and even in the sub- 
stance of the infraspinatus muscle. 

The descending branch goes inward, backward, and downward, along 
the external wall of the chest, in the broad muscles of the back, the lower 
part of the serratus magnus muscle, the intercostales muscles, the tho- 
racic glands, the lower part of the subscapularis muscle, and several of 
the axillary ganglions. 

The portion of this branch which is distributed in the serratus mag- 
nus muscle is the long external thoracic artery, which very rarely arises 
from the trunk of the axillary artery. 

III. CIRCUMFLEX ARTERIES OF THE ARM. 

§ 1410. There are two circumflex arteries of the arm (A. circumflexes, 
s. artictdares humeri), an anterior and a posterior. 

a. Anterior circumflex artery of the arm. 

§ 1411. The anterior circumflex artery of the arm (A. circumflexa 
anterior humeri, s. articularis anterior) often arises a little higher than 
the posterior, sometimes also much higher, in some cases at the same 
height, and sometimes still lower. 

It is always much smaller than the latter, but it rarely arises from it 
or from the subscapular artery(l). It comes very constantly from the 
outer and anterior side of the axillary artery, a little above the upper 

(1) We have never seen it arise from the deep brachial artery, of which Mayer (p. 
123) asserts it is sometimes a branch. 



272 DESCRIPTIVE ANATOMY. 

edge of the tendon of the latissimus dorsi muscle. It goes outward on 
the anterior part of this tendon, directly on the humerus, below the 
common tendon of the biceps flexor and of the coraco-brachialis mus- 
cles, to which it gives ramuscules, and also to the periosteum, and di- 
vides into upper and lower branches. The latter are fewer and smaller 
than the former ; they turn inward, some go partly to the internal por- 
tion of the deltoides muscle, where they anastomose with the posterior 
circumflex artery, while the others pass downward on the tendon of 
the latissimus dorsi muscle, to which they give branches, and anasto- 
mose with the recurrent branches of the superficial brachial artery. 

The upper branches are larger and more numerous, and proceed 
directly on the humerus ; they ascend toward the upper part of the 
humerus and give ramifications to this bone, expand in the scapulo- 
humeral articulation, penetrate to the supraspinatus and the infraspi- 
natus muscles, and anastomose with all the arteries of the shoulder 
which arise from the subclavian and the axillary arteries. 

Sometimes another analogous artery exists, which distributes its 
branches principally to the latissimus dorsi, to the upper part of the 
biceps flexor, and to the brachialis internus muscles. This artery is 
frequently only a branch of the anterior circumflex artery. 

b. Posterior circumflex artery of the arm. 

§ 1412. The posterior circumflex artery of the arm (A. circumflexa 
humeri posterior) is always much larger than the preceding. It arises 
from the subscapular or from the deep brachial artery by a common 
trunk, which varies in length but is never very long, more frequently 
than from the axillary artery. It very rarely forms a common trunk 
with the anterior circumflex artery, and when this anomaly occurs, the 
subscapular artery also arises from this trunk. In the former case it 
arises no higher, or at most not much higher, than when it comes 
directly from the axillary artery. But when it comes from the axillary 
artery it is lower than usual by the length of the whole tendon of the 
latissimus dorsi muscle, sometimes by about two inches ; for in all the 
cases at least where we have observed this arrangement (which, so far 
from being rare, is perhaps the most common), the deep brachial artery 
arose as usual. The posterior circumflex artery is then reflected from 
below upward, behind the tendon of the latissimus dorsi muscle, and 
ascends between the two heads of the biceps flexor muscle until it 
comes a little above the upper edge of this tendon, that is, until it rises 
as high as its normal origin. It then goes backward to turn on the 
humerus. We have sometimes seen the deep brachial artery arise 
very high and near the posterior circumflex artery ; but we have never 
found that it then came from the same trunk as the latter, which has 
led us to think that when these two vessels arise from a common trunk 
we must not consider the deep brachial artery as a branch of the pos- 



ANGEIOLOGY. 273 

terior circumflex artery, as Murray(l) and Scemmerring(2) have done, 
but we must regard the posterior circumflex artery as a branch of the 
deep brachial. (3) 

The posterior circumflex artery is reflected outward and forward on 
the neck of the humerus, between this bone and the long head of the 
triceps extensor muscle. Proceeding onward, it distributes branches to 
this long head, to the capsular ligament of the scapulo-humeral articu- 
lation, to the teres minor and to the outer head of the triceps muscle. 
After giving off these branches, which are proportionally very small, 
it proceeds inward on the inner face of the deltoides muscle, in which 
it is entirely lost, and of which it is the principal artery. It anasto- 
moses behind and above it with the anterior circumflex, the subscapu- 
lar, and the superior scapular arteries. 

The axillary artery sometimes gives off, above or below these two 
arteries, some small branches, which enter the biceps flexor, the long 
head of the triceps, the teres major, and the latissimus- dorsi muscles. 

III. BRACHIAL ARTERY. 

§ 1413. When the artery of the upper extremity leaves the axilla 
at the upper edge of the tendon of the latissimus dorsi muscle, it is 
called the brachial humeral artery {A. brachialis, s. humcraria). It 
goes between the insertions of the teres major and latissimus dorsi mus- 
cles and the coraco-brachialis, which it covers, to the inside of the biceps 
flexor muscle and to the inner face of the arm ; so that it] crosses the 
direction of the humerus and becomes more superficial the farther it 
descends, since toward its lower extremity it is covered only by the 
brachial aponeurosis and the median vein and the skin. Its upper part 
rests directly on the humerus, and the lower on the brachialis internus 
muscle. It usually extends to the anterior face of the humero-cubital 
articulation, near which it terminates in most subjects. It not unfre- 
quently however terminates higher, and sometimes does not exist at all, 
and then the branches usually given off in the elbow arise in the 
axilla. 

The largest and'uppermost branches go inward ; they form the deep 
brachial artery or arteries. The origin of this artery, especially when 
it gives off branches which usually come from the axillary artery, as 
particularly the posterior circumflex artery of the arm or the subsca- 
pular artery, may often be considered as a point where the brachial 
artery divides into two branches, a superficial, which is the continuation 
of the trunk, and a deep branch. 

§ 1414. The deep brachial or external collateral artery, Grand mus- 
cidaire du bras, Ch. (A. profunda humeri, s. brachii, s. collateralis 

(1) Descript. art. in tab. redacta, p. 41. 

(2) Scemmerring-, Gefasslchre, p. 206. 

(3) This remark has not escaped Mayer, who says (loc. cit., p. 123) that one or even 
both the circumflex arteries arise from the deep brachial artery in rare cases. 

Vol. II. 35 



274 DESCRIPTIVE ANATOMY. 

magna, s. superior), usually arises below the lower edge of the latissi- 
mus dorsi muscle, above the small head of the triceps extensor muscle. It 
accompanies the radial nerve, which it almost always covers, pene- 
trates between the three heads of the triceps muscle, to which it gives 
branches, turns from within outward upon the humerus, so that its 
lower extremity is situated on the outside of this bone, and commonly 
terminates at the articulation of the elbow, where it is distributed to the 
supinator longus and the extensor carpi radialis muscles. It also sends 
branches to the brachialis interims and to the anconeus muscle, sup- 
plies the nutricious artery of the humerus near the centre of its course, 
and having come to the outside of the elbow, it penetrates into the an- 
coneus muscle, where, termed the collateral radial artery (A. collaie- 
ralis radialis, s. communicans radialis a profunda), it anastomoses with 
the recurrent branch of the ulnar artery. One of these branches, which 
sometimes arises from the brachial artery, always lower than it but 
directly under it and sometimes a little distance from it, and which is 
always smaller, goes farther forward, descends between the long and 
short portions of the triceps to which it gives branches, anastomoses 
with the inferior lateral branch of the brachial, and communicates, un- 
der the name of the collateral ulnar artery {A. collateral'^ ulnaris, s. 
communicans ulnaris a profunda), with the recurrent branch of the 
interosseous and ulnar arteries, on the inner and posterior face of the 
humero-cubital articulation. 

Thus the deep brachial artery is distributed principally to the exten- 
sor muscles of the fore-arm. It anastomoses above with the subclavian 
and below with the trunk of the brachial artery and with the arteries 
of the fore-arm. 

§ 1415. Below or above the deep brachial artery, when it is single, 
or even between it and the collateral ulnar artery, when the latter forms 
a distinct trunk, we usually see arise a branch, which goes to the longer 
portion of the triceps muscle and which anastomoses with the posterior 
circumflex artery of the arm. This branch sometimes arises from the 
deep brachial artery. The brachial artery then gives off, forward, out- 
ward, and backward, at right angles, about twelve very short differently 
sized branches, which penetrate into the biceps and the brachialis in- 
ternus muscle. Some of them go only to one of these muscles, but 
most of them are common to both. One of the largest, which arises 
from the posterior and internal part of the brachial artery, about two 
inches above the elbow, is called the large anastomotic or internal col- 
lateral branch, or more properly the inferior anastomotic branch, or the 
inferior deep brachial artery (R. anaslomoticus magnus inferior, s. A. 
profunda inferior) ; the first of these terms is applied to it because it 
establishes a communication between the. trunk of the brachial artery 
and the arteries of the fore-arm. It proceeds inward, passing on the 
brachialis intern us muscle, to which it gives ramuscules, as also to the 
pronator teres, unites first by a transverse branch with the ulnar branch 
of the deep brachial artery, which connects it with the recurrent branch 



ANGEIOLOGY. 275 

Of the ulnar artery ; then anastomoses on the posterior face of the arti- 
culation of the elbow with the radial branch of the deep brachial artery, 
and thus forms the dorsal arch of the elbow (arcus dorsalis articularis 
cubitalis), and communicates in this manner with all the anastomosing 
branches of the fore-arm. 

This branch sometimes comes from the radial artery when the latter 
arises much higher than usual, but its origin is not constant, and then 
it is sometimes supplied by the continuation of the trunk of the brachial 
artery — an arrangement which Bichat(l) erroneously considers as a 
general law in such cases. This branch comes from the ulnar artery 
much less frequently when the latter is given off much higher than 
usual. It rarely sends off from its outside, above the articulation of the 
elbow and directly above where the brachial artery bifurcates to give 
rise to the two arteries of the fore-arm, a considerable branch, which 
ordinarily comes from the radial artery, and which is called the recur- 
rent radial artery (Jl. radialis recurrens).{2) 

The two large anastomoses which we have described permit the ap- 
plication of a ligature upon all parts of the brachial artery, without 
causing any derangement in the circulation and nutrition of the fore- 
arm. 

IV. ARTERIES OF THE FORE-ARM. 

§ 1416. The brachial artery usually divides a little below the elbow, 
where the tendon of the biceps penetrates between the muscles of the 
fore-arm, into two branches, the radial and the ulnar artery. This 
bifurcation rarely and perhaps never takes place much lower, while it 
not unfrequently occurs higher than usual. Of the two trunks of the 
fore-arm, the radial is the continuation of the brachial artery as respects 
its direction, but in most cases it is smaller than the ulnar artery, at 
whatever height the brachial artery divides. It is nearer the surface 
than the latter and arrives at the lower extremity without giving off 
any considerable branches except one, which arises from its upper part. 
The ulnar artery, on the contrary, soon divides into two branches, one 
of which is the proper continuation of the trunk, and the other the inter- 
osseous artery. 

I. ANOMALIES IN THE ORIGIN OF THE ABTEHIES OP THE FOBE-ARM. 

§ 1417. The brachial artery not unfrequently divides unusually 
high (§ 1416). (3) This anomaly varies in its mode and degree. 
The principal laws in both these respects are as follow : 

(1) Anal, deserip., vol. iv. p. 230. 

(2) This arrangement is very rare. We have seen it but once only, and we cannot 
find it mentioned by any writer. It does not affect the anastomoses around the elbow 
joint, because in this instance the recurrent radial artery did not arise much higher 
than usual. J b 

(3) See our Mimoire sur les diffirentcs varietes qu'on observe dans la distribution 
cte l artere brachialc; in the Journ. compl. du diet, des sc. mcd., vol. iii. p. 31.— We 



276 DESCRIPTIVE ANATOMY. 

a. In regard to mode, we observe three principal differences. In 
fact, the artery which arises unusually high is sometimes the radial, 
sometimes the ulnar, and finally sometimes the interosseous artery. 
Observation confirms what might be admitted on conjecture, that the 
first of these three anomalies is the most common and the last the 
rarest ; which evidently depends on the fact, that in producing the first, 
nature conformed to the primitive type in this respect, that the artery 
which is generally given off first, that is the radial artery, generally 
arises higher than usual. In the second anomaly, although the division 
takes place higher than usual, there is also an inversion, since the inter- 
osseous artery comes from the radial artery and the ulnar artery arises 
above the latter. Finally, in the third the anomaly is still greater, 
since a vessel usually given off by a branch of the brachial artery, the 
ulnar artery, arises directly from the trunk. 

The ulnar and radial arteries are distinguished from each other when 
they arise higher than usual, because the former is commonly more 
superficial than the latter, and it then is frequently situated between 
the aponeurosis and the skin, an arrangement which, judging from our 
observations, is not always constant. 

But in whatever manner this abnormal division of the brachial artery 
above its usual point occurs, the vessel which it thus prematurely pro- 
duces is always situated in the arm, directly at the side of the superfi- 
cial brachial artery. 

b. In regard to the degree, we may consider the anomaly either in 
itself or in relation to the whole vascular system. 

First, considered in regard to itself, it presents several differences, of 
which the principal are as follow : 

1st. The first degree consists in the existence of abnormal vessels 
(vasa aberrantia), greater or less branches, which arise from the upper 
part of the superficial brachial artery, and empty into its lower part, or, 
as is more common, into an artery of the fore-arm, particularly the 
radial artery. In this case both the normal and the abnormal division 
exist, and the artery of the fore-arm, into which the abnormal vessel 
empties, arises in fact by an upper and a lower root. The normal type 
gradually passes to the abnormal formation by the increase of the first 
of these roots and the diminution of the second, until the latter type is 
perfect, when the lower root entirely disappears. 

2d. A second degree is when the brachial artery divides more or less 
above its usual place. This division occurs in fact in all parts between 
the axilla and the humero-cubital articulation. The three arteries of 
the fore-arm differ from each other in this respect, that although the 
radial artery arises unusually high much more frequently than the 
ulnar artery, still when the anomaly exists, the ulnar artery comes from 
a higher point, particularly from the axillary artery itself, while the 

have there given our own observations and the principal of those collected by other 
authors. 






ANGEIOLOGY. 277 

radial artery is given off near the middle of the arm. When the inter- 
osseous artery is abnormal in this respect, it arises either from the angle 
of the bifurcation as usual or from a higher point. 

Second, considered in regard to the whole vascular system, this ano- 
maly exists on one side only or on both sides at once. Bichat asserts 
that he has seen the first case oftener than the second, but our own ob- 
servations and those of other anatomists prove the contrary. 

This anomaly however is by no means the same on both sides in 
regard to the manner and the degree, and we more commonly observe 
differences in one or the other of these two relations than the contrary, 
or a perfect similitude between the two sides of the body. We cannot 
yet say if the anomaly is observed on the left side more frequently than 
on the right when it is seen only on one side, and if it is more distinct 
on this side than on the other when it occurs on both sides, although 
this seems very probable, reasoning from the difference between the 
formative types of the two sides, and also from other anomalies, and 
from the observations which we have been able to collect. 

All these anomalies are equally important in a physiological or sur- 
gical point of view. They concern physiology, because they imitate 
the two superficial veins of the arm. The surgeon ought always to 
observe them carefully, because they increase the chance of injury to 
the arteries of the arm, and because, when the course of the blood in 
the brachial artery is in any manner interrupted, it re-establishes the 
circulation in the upper extremity more easily. 

II. RADIAL ARTERY. 

§ 1418. The radial artery (A. radialis) is usually much smaller 
and nearer the surface than the ulnar artery ; but in considering its 
direction only, it is a continuation of the trunk of the brachial artery. 
It is much smaller when the recurrent radial artery arises from the 
brachial artery. Less frequently still it is larger, which occurs when 
the interosseous artery arises from it instead of coming from the ulnar 
artery as usual. 

This artery descends a little obliquely from behind forward, along 
the radius, to the radio-carpal articulation, where it glides under the 
tendons of the extensor digitorum communis muscle, and penetrating 
into the palm of the hand, between the first and second metacarpal 
bones, it anastomoses with the ulnar artery. 

§ 1419. The first branch of the radial artery is generally the recur- 
rent radial artery (A. recurrens radialis), when the latter does not 
come from the brachial artery, which rarely happens. It arises as 
rarely from the ulnar artery, which we have observed only a few times, 
when the radial artery arose much higher than usual ; even then the 
recurrent radial artery can be considered only as divided into two por- 
tions, for the radial artery gives off a muscular branch, which is de- 
tached higher than usual. In the most frequent cases, in fact, the 



278 DESCRIPTIVE ANATOMY. 

brachial artery divides into three trunks and gives off the recurrent 
branch at the place with the two others ; but this artery constantly 
arises very high from the radial artery, which even in the adult passes 
through but a very few lines before it is sent off. It is always the 
largest branch which this artery gives to the fore-arm ; so that we may 
say that the radial artery, as soon as it arises, divides into two branches, 
one of which continues to proceed in the direction of the trunk and is 
the proper radial artery, and the other is smaller and is the recurrent 
artery. The latter gives branches to the pronator teres, the supinator 
longus, the supinator brevis, and the extensor carpi radialis muscles, to 
the capsular ligament, to the inner portion of the triceps extensor, and i* 
reflected from below upward, between the supinator longus and the 
extensor carpi radialis longus, to anastomose with the recurrent radial 
artery given off by the deep brachial artery on the inner tuberosity of 
the humerus. 

At the same place, sometimes a little higher, the radial artery gives 
off a small recurrent branch, which goes into the lower part of the inner 
portion of the brachialis internus muscle. It then gives off from its outer 
and inner sides, and at right or nearly light angles, and very near each 
other, small branches, almost uniform in size, and at least forty in num- 
ber. Of these, the internal are distributed to the pronator teres, the 
flexor carpi radialis, the flexor digitorum sublimis, the flexor pollicis lon- 
gus, the pronator quadrat us muscle, and the capsule of the radio-carpal 
articulation ; while the external are distributed in the pronator teres, 
the pronator quadratus, and the extensor carpi radialis. 

§ 1420. Toward the lower end of the radius, the radial artery constant- 
ly gives off a branch, which passes on the radial edge of the carpus, enters 
into the palm of the hand, and is called the superficial palmar artery 
{A. superficialis voice). This branch is always situated below the 
palmar aponeurosis, and proceeds toward the ulnar edge of the hand 
to meet the ulnar artery. This branch is sometimes and not rarely so 
large, that we have reason to say that the radial artery bifurcates in 
the place where it arises to produce it and also the continuation of the 
trunk which goes on the back of the hand. When this branch is small, 
it is frequently but not always distributed only to the small muscles of 
the thumb. When it is considerable, it usually but not always anas- 
tomoses with the ulnar artery to form the superficial palmar arch (arcus 
volaris superficialis), and contributes as much as the latter to produce it. 

Sometimes the superficial palmar artery arises much higher than 
usual and proceeds in the same direction as the radial artery, with 
which however it cannot be confounded, as it is more superficial and 
less fixed in its situation. 

It is essential to remember this circumstance, in order not to be in 
error when we wish to ascertain the state of the pulse by feeling the 
radial artery. 

§ 1421. When the superficial palmar artery concurs to form a super- 
ficial palmar arch, it gives off very distinctly some digital palmar 



ANGEIOLOGY. 279 

arteries (A. digilales volares). In two preparations now before us it 
gives off the digital palmar artery of the thumb (A. digitalis volaris 
ulnaris pollicis) and the digital palmar artery of the index finger (A. 
digitalis volaris radialis indicis). 

Usually, when the superficial palmar artery is not very small, the 
superficial palmar arch is double, because, beside the large anastomosing 
anterior twig of this branch, we find another, which is smaller and 
more transverse and posterior. 

However small the superficial palmar artery may be, and even when 
it does not contribute to form the superficial palmar arch, it however is 
never entirely deficient, and always anastomoses with the continuation 
of the trunk of the radial artery at the bottom of the palm of the hand. 
We have never seen it arise except under the pronator quadratus, or at 
least toward its posterior edge, and constantly below the place where 
the radial artery rests almost directly on the radius. We must except 
some but not all those cases, where the radial artery arises from the 
brachial artery extremely high, and, imitating the type of the latter, 
bifurcates unusually high, for instance near the elbow. 

§ 1422. After giving off the superficial palmar artery, the continua- 
tion of the trunk of the radial artery goes usually on the back of the 
hand, passing between the styloid process of the radius and the os tra- 
pezium ; but sometimes it is reflected higher on the outer face of the 
radius and of the fore-arm, and produces the following branches : 

1st. Branches which go to the ligaments of the carpus and also to 
the flexor brevis pollicis and the abductor pollicis proprius. 

2d. The dorsal artery of the thumb (A. dorsalis pollicis), which arises 
from its outside, extends along the radial edge of the metacarpal bone 
of the thumb and of all the phalanges of this finger, anastomoses with 
its digital palmar artery, and rarely arises from the superficial palmar 
artery given off by the radial artery. 

3d. The dorsal artery of the carpus (A. dorsalis carpi radialis) arises 
from the inside of the radial artery, more or less opposite the preceding, 
goes transversely toward the ulnar edge of the hand, and passing under 
the tendons of the extensor muscles, directly on the dorsal ligaments of 
the carpus, anastomoses with some small branches of the radial artery 
which were given off higher than the latter, then with the extremity 
of the interosseous artery, finally with the dorsal branch of the ulnar 
artery, and thus forms the dorsal arch of the carpus (arcus dorsalis 
carpi), which resembles an arch less than a net-work with large 
meshes. 

§ 1423. The dorsal interosseous arteries (A. dorsales inlerosseai) arise 
principally from this arch. They proceed from behind forward in the 
spaces between the metacarpal bones from the second finger to the fifth, 
go to the external interosseous muscles,and are continuous, first, forward,' 
with the corresponding digital arteries between the posterior extremi- 
ties of the first phalanges, in the place where the trunk of these arteries 
bifurcates ; second, with the inferior metacarpal arteries, whence results 



280 DESCRIPTIVE ANATOMY. 

a large circle of anastomoses between the dorsal and the palmar branches 
of the arteries of the fore-arm. 

§ 1424. Next come smaller ramifications, which enter the abductor 
indicis proprius muscle and the ligaments of the carpus ; then, between 
the posterior extremities of the first two metacarpal bones, arise the 
dorsal cabital artery of the thumb (*#. dorsaiis ulnaris pollicis) and the 
dorsal radial artery of the index finger (A. dorsaiis radialis indicis), 
which arise sometimes separately and sometimes by a separate trunk. 
§ 1425. When the radial artery has given off these branches, it en- 
ters into the palm of the hand between the first two metacarpal bones 
and the adductor indicis muscle, goes transversely toward the ulnar 
edge, and anastomoses with the ulnar artery, which meets it so as to 
form a deep palmar arch (arcus volaris profundus), and contributes to 
produce it more than the latter. When passing on the posterior extre- 
mity of the metacarpal bone of the index finger, it gives rise to the large 
artery of the thumb (A. princeps, s. magna pollicis). The latter divides 
sometimes into the palmar radial and the palmar ulnar artery of the 
thumb (A. volaris pollicis radialis et ulnaris), sometimes furnishes only 
one of these two branches, while the other arises near the superficial 
or from the deep palmar arch ; but it always anastomoses by one or 
two large branches with the radial and the ulnar dorsal arteries of the 
thumb, even when the corresponding palmar arteries do not arise 
from it. 

The radial artery rarely divides, when passing through the first inter- 
osseous space, into two branches, one of which is the continuation of 
the trunk and goes into the palm of the hand, while the other is smaller, 
passes over the internal belly of the first external interosseous muscle, 
and anastomoses with the superficial palmar arch, giving origin to the 
palmar cubital artery of the thumb {A. volaris idnaris pollicis), where 
it divides into this artery and the palmar radial artery of the index 
finger (A. volaris radialis indicis), which formation is remarkable be- 
cause it strengthens the resemblance with the arteries of the other 
fingers, as this dorsal branch then represents the first dorsal metacarpal 
artery, which is the largest. Sometimes but very rarely these arteries 
do not arise from the large artery of the thumb, but from the superficial 
palmar arch and directly from the superficial palmar radial artery. 
In this case the palmar and the large arteries of the thumb, which are 
proportionally smaller, give off only the dorsal arteries of the thumb. 
Nevertheless, we have never seen this arrangement except when the 
radial and the palmar radial arteries arose unusually high. 

Even at the place where the large artery of the thumb arises, and 
only little more on the anterior side of the radial artery, a very constant 
branch arises, which however varies in size ; this goes inward and 
passes directly on the palmar face of the second metacarpal bone, gives 
branches to the adductor pollicis muscle, and contributes more or less 
to form the palmar arteries of the index finger. This however is not 
always the case ; so that the radial artery of this finger always comes 



ANGEIOLOGY. 281 

from the branch of which we were speaking, as Soemmerring pretends ; 
for we have sometimes seen, notwithstanding the considerable size of 
the latter, the radial artery of the index finger coming from the super- 
ficial palmar arch. We may then, in order to express the analogy be- 
tween it and the large artery of the thumb, term this branch the large 
artery of the index finger (A. princeps indicts). 

Wo shall describe the deep palmar arch when speaking of the ulnar 
artery. 

III. ULNAR ARTERY, 

§ 1426. The ulnar artery (A. ulnaris, s. cubitalis) is generally the 
largest of the two branches produced by the bifurcation of the brachial 
artery ; it goes toward the ulna sooner after arising, passes below the 
pronator teres, and proceeds toward the hand, along the ulna, between 
the flexor ulnaris and the flexor digitorum profundus muscles, and is 
always situated deeper than the radial artery. It gives off near its 
origin a small or large branch, the anterior recurrent ulnar artery, 
which penetrates to the lower extremity of the inner portion of the tri- 
ceps extensor and also into the upper extremity of the pronator teres, 
and corresponds to a similar branch given off by the radial artery. 

§ 1427. It then sends off the recurrent or the posterior recurrent 
ulnar artery {A. recurr ens ulnaris, s. cubitalis), which is generally much 
larger than the preceding, and proceeds from below upward between 
the flexores digitorum sublimis and profundus and the flexor ulnaris, 
distributes branches to these muscles, penetrates through the latter, 
and ascends between the inner condyle of the humerus and the olecra- 
non process, and unites with the inferior and internal collateral artery 
which comes from the brachial artery, and thus forms the largest anas- 
tomosis which exists around the humero-cubital articulation. This 
artery always arises much lower than the recurrent branch of the 
radial artery. It comes very constantly from the ulnar artery, when 
the latter arises as usual from the brachial artery ; at least we have 
never seen it arise directly from the humeral artery, as does the recur- 
rent radial artery, which undoubtedly must be attributed to its arising 
so low. On the contrary, in all those cases where the ulnar artery 
ascended unusually high, the recurrent artery was not given off by it 
but by the interosseous artery ; so that then even the anomaly ap- 
proached as near as possible the normal formation. 

§ 1428. Soon after giving off this branch, the ulnar artery divides 
into two others, the proper ulnar artery and the interosseous artery (A. 
interossea), which is usually smaller than the other. The latter is 
rarely given off by the brachial artery, either at the usual place of its 
bifurcation(l) or above this point.(2) When the ulnar artery arises 

(1) Barclay, Description of the arteries of the human body ; in the Edinb, Med. and 
Surg. Journ., vol. viii. p. 468. 

(2) Monro, Outlines of Anatomy, vol. iii. p. 304. 
Vol. II. 36 



282 DESCRIPTIVE ANATOMT. 

unusually high, the interosseous artery is a branch of the radial artery, 
whence it arises in the same region of the fore-arm, although it come* 
from a different artery. 

From these two causes the ulnar artery is much smaller than usual 
when it arises uncommonly high. This diminution of caliber is some- 
times observed in it, although its origin is not abnormal, because the 
interosseous artery, although very rarely, arises from the radial. 

The interosseous artery gives off near its origin one or two very con- 
stant branches, which descend into the upperpartof theflexoresdigitorum 
sublimis and profundus, into the flexores carpi radialis longus and brevis 
muscles, and the pronator teres. Lower down it divides into two 
branches, nearly equal in size, one of which is a little larger and is a 
continuation of the trunk, and descends on the anterior face of the inter- 
osseous ligament, while the other passes above the upper edge of this 
ligament to go to the dorsal face of the fore-arm. This branch is the 
superior perforating artery {Jl. p erf or ans prima supremo), which soon 
divides into two branches. The smaller, which is however considerable, 
is called the recurrent interosseous artery {Jl. recurrens inlerossea), re- 
ascends above the extensor carpi ulnaris muscle, between the radius and 
the ulna on one side and the anconeus muscle on the other, and empties 
into the dorsal arch of the articulation of the elbow. The larger de- 
scends between the origin of the extensor longus and the abductor pol- 
licis longus on the one side, the extensor digitorum and the extensor 
carpi ulnaris on the other, along the ulna to its lower extremity, and in 
its course gives off numerous branches to the muscles which we have 
mentioned. 

§ 1429. The trunk of the interosseous artery descends in most of its 
extent on the anterior face of the interosseous ligament, between the 
two bones of the fore-arm, a little nearer the ulna than the radius, gives 
small twigs to all the flexor muscles, and also supplies six or seven 
branches, the inferior perforating arteries {Jl. perforanles minores in- 
feriores), which pass through the interosseous ligament, glide on the 
posterior face of the fore-arm, and are distributed in the extensor mus- 
cles. The arterial trunk terminates in passing above the upper edge 
of the pronator quadratus to the dorsal face of the fore-arm, where it 
divides into three or four branches, nearly equal in size. One or two 
of these branches are distributed partly in the extensor and the abduc- 
tor pollicis and partly also pass under the tendons of these muscles, 
resting directly on the bone, turn on the radius, and anastomose with 
the branches of the radial artery. The second or the third, which re- 
trogades on the ulna, anastomoses with the superior perforating artery. 
The third or the fourth, which is the continuation of the trunk, descends 
between the two bones of the fore-arm and forms the dorsal arch of the 
carpus (arcus dorsalis carpi) on the back of the carpus, and divides into 
a middle and at least two lateral ramuscules, which communicate with 
the carpal branches of the radial and ulnar arteries 



ANGEIOJLOGY. 283 

§ 1430. The trunk of the interosseous artery rarely gives off a long 
branch, which descends between the flexor muscles of the fingers to 
the hand and contributes to form either the superficial palmar arch or 
the arteries of the thumb. This is seen particularly when the ulnar 
artery arises higher than usual, a very remarkable circumstance, as it 
shows an effort to approximate the anomaly to the normal formation. 

§ 1431. The ulnar artery, after giving off the interosseous artery, 
sends off like the radial, at short intervals, numerous ramuscules, which 
are distributed to the muscles between which it descends, the flexors 
of the fingers, and the extensor carpi ulnaris muscle. Near the lower ex- 
tremity of the ulnar and about an inch above the radial artery, it divides 
into two branches, the larger of which is the continuation of the trunk, 
while the other is smaller and is called the dorsal ulnar artery (A. dor- 
salts ulnaris, ramus dorsalis ab ulnari). The latter is reflected above 
the tendon of the flexor ulnaris muscle, on the lower extremity of the 
ulna, sends branches to the flexor ulnaris and to the pronator quadratus 
muscle, also to the ligaments of the carpus, anastomoses with the dorsal 
branch of the radial and with the interosseous artery, gives rise to the 
dorsal arch of the carpus, and terminates in the fourth internal inter- 
osseous muscle, also in the muscles of the index finger, especially the 
abductor muscle. 

§ 1432. After giving some small branches to the palmar ligament 
of the carpus, the ulnar artery divides, near the posterior extremity of 
the fifth metacarpal bone, into two branches, the superficial and the 
deep palmar artery (ramus volaris superficialis et profundus.) 

IV. PALMAR ARCHES. 

§ 1433. There are two palmar arches (arcus voice), a superficial and 
a deep. 

The superficial palmar branch of the ulnar artery is usually 
much larger than the deep. It passes above the tendons of the flexor 
muscles which previously covered the ulnar artery, advances imme- 
diately below the palmar aponeurosis toward the radial edge of the 
hand, and anastomoses with the superficial palmar branch of the radial 
artery, which it always exceeds in volume, even when the latter is un- 
usually large. These two branches join and form the superficial palmar 
arch (arcus superficialis voice). This arch is not unfrequently formed 
entirely by the ulnar artery, which does not then anastomose with the 
palmar branch of the radial artery, or communicates with it only by 
some trifling ramuscules. 

The collateral arteries of the fingers (A. digitales) arise from the 
superficial palmar arch, but not constantly in the same manner. The 
only rule which we can establish in this respect is, that most of the 
digital arteries arise directly or indirectly from the superficial arch, from 
the deep arch, or from both at once, and always arise two and two from 
a single trunk ; so that this single trunk extends from the arch to the 



284 DESCRIPTIVE ANiTOMY. 

extremity of the first phalanx and there divides into two branches, 
which are unequal and often disproportional in size, which always be- 
long to two different fingers and never to one only. These branches 
proceed on the palmar face of the fingers, along the radial edge of one 
and the ulnar edge of the other. Each finger thus receives two collateral 
arteries, the ulnar of which is always the larger. 

The little finger usually- receives a proper or special ulnar artery, 
the first branch of the superficial palmar arch which goes to it, pro- 
ceeding along the flexor minimi digiti brevis muscle, to which it sends 
numerous ramuscules. 

Some distance from this branch, and very near each other, arise three 
very constant arteries, the second, the third, and the fourth collateral 
arteries, which go, the first to the radial side of the fifth finger and the 
ulnar of the fourth, the second to the radial side of the fourth and the 
ulnar side of the third finger, and the last to the ulnar side of the second 
and to the radial side of the third. 

Farther, we generally find a fourth common collateral artery, which 
divides into the artery of the radial side of the index finger and the artery 
of the ulnar side of the thumb. 

This arrangement presents only a few unimportant anomalies, the 
principal of which are : 

Sometimes the second collateral artery, the ulnar branch of the fifth 
finger, belongs not so much to the superficial as to the deep palmar 
arch, of which it is the posterior part, — that by means of which this 
arch communicates with the other ; so that it must be considered as an 
anastomosing branch between the two arches. The fourth collateral 
artery, which goes to the radial side of the third and the ulnar side of 
the second finger, sometimes presents the same anomaly. These two 
differences arise because the two arteries always communicate with the 
deep arch by large anastomosing branches, while the other two middle 
collateral arteries are more insulated and more independent. 

The union of several digital arteries in a common trunk, which is 
always very short, forms a second anomaly. To this there is a gra- 
dual transition by a case which is sometimes observed, viz. the approx- 
imation of two branches to each other. 

Thus we have often seen coming from a common trunk the first 
and second, the third and fourth, or the fourth and fifth, which then 
went only to the radial side of the index finger. When the artery of 
the little finger does not form a small distinct trunk, but comes from the 
second, the common trunk is a little longer than that which appears 
when the branches are united, and the second goes almost always to 
the ulnar side of the fourth finger and the radial side of the fifth. 

§ 1434. The deep or the smallest ulnar artery turns deeply from be- 
hind forward on the flexor minimi digiti brevi.s muscle, goes always 
outward toward the radial side of the hand, so that it proceeds trans- 
versely on the internal interosseous muscles to meet the deep palmar 
artery, with winch it anastomoses, and forms the deep palmar arch 



ANGEIOLOGT. 285 

{arcus palmaris profundus). This arch is sometimes larger and some- 
times smaller than the superficial, but smaller more frequently than 
larger, and its caliber is always greater on the radial than on the ulnar 
side, because the radial artery concurs to form it more than the ulnar 
artery. It is always situated farther back than the superficial arch, 
and is placed directly before the posterior extremity of the metacarpal 
bones. 

§ 1435. The deep palmar arch produces, 

1st. From its anterior side or its convexity, the palmar interosseous 
-arteries (A. interosseoz volares), or the inferior perforating arteries (A, 
perforantes infer tores), which are the largest of all its branches. 

These arteries go to the internal interosseous muscles in the spaces 
between the metacarpal bones, give branches to the muscles in these 
regions, and one or the other at least, and sometimes all, anastomose at 
their anterior extremity with the collateral arteries of the fingers, where 
the latter bifurcate, and also with the superior interosseous arteries. 

They correspond to the collateral arteries of the fingers, but are 
usually much smaller. The first however is generally much more de- 
veloped than the others. Hence we have proposed to term it the large 
artery of the index finger (A. indicis princeps) (§ 1425). Sometimes 
however other arteries among the inferior interosseous arteries are un- 
usually large ; so that they are as large or nearly as large as the 
common trunks of the collateral arteries which arise from the large 
arch, and the digital arteries also arise as much and even more from 
the deep than from the superficial arch. 

Sometimes but more rarely they exceed almost all the collateral 
arteries of the fingers in volume, and the palmar arteries of the fingers 
arise more than they from the superficial arch, as is frequently the case 
with the index and little finger. 

2d. The superior or posterior perforating arteries (A. perforantes, 
s. posteriores, s. superiores) arise from the convexity of the deep palmar 
arch. They penetrate between the posterior extremities of the meta- 
carpal bones, give ramifications to the posterior part of the lurnbricales 
muscles, and come on the back of the hand, where they anastomose 
with the anterior part of the dorsal arch of the carpus and with the 
superior metacarpal arteries, which are given off by this arch less fre- 
quently than by them (§ 1432). 

. § 1436. Thus the two palmar arteries concur simultaneously to pro- 
duce the digital arteries. The superficial arch contributes most to the 
origin of the palmar branches of the third, of the fourth, fifth, and of 
the ulnar side of the index finger ; the deep, on the contrary, assist 
more in forming the palmar branches of the thumb and of the radial 
side of the index finger. Sometimes however the latter arise entirely 
from the superficial arch, but this is true of the radial artery of the index 
finger and the ulnar artery of the thumb more frequently than of the 
radial artery of the thumb. In this case the two branches arise by a 
common trunk. When all the digital arteries, not excepting those of 



286 DESCRIPTIVE ANATOMV. 

the thumb, come from the superficial palmar arch, this divides some- 
times at the lower part of the hand into two large principal branches, 
one of which gives off the twigs which usually arise from the superfi- 
cial arch, and the other bifurcates to give rise to the principal artery 
of the thumb and the radial branch of the index finger, which deserves 
to be remarked, as it shows that nature endeavors to approximate to 
the normal type even in the greatest anomaly. The superficial 
palmar artery of the radius does not then exist or is very slightly 
developed. It sometimes, on the contrary, contributes more than 
usual to produce the superficial palmar arch, and then it gives off also 
all the digital arteries ; but the ulnar and the radial arteries are not 
then always connected, except by a small anastomosing branch, which 
is sometimes entirely deficient, and each of the two arteries produces 
only the branches which go to the corresponding side of the hand. 

The two palmar arteries anastomose at the bifurcation of the digital 
arteries and produce the two collateral arteries. They communicate 
by long branches, which are usually much smaller than the common 
trunks of the digital arteries. The largest and most constant of these 
branches are situated between the ulnar artery of the little finger and 
the common artery of the second and third. 

The dorsal arch of the carpus and the deep palmar arch communi- 
cate by the posterior or superior perforating arteries and the dorsal 
interosseous arteries. The last and the inferior interosseous arteries 
establish a communication between these two arches and the superficial 
palmar arch. 

V. DIGITAL -ABTERIEB. 

§ 1437. Although the digital arteries arise in most cases from the 
superficial arch (§ 1433), we may however say, that the deep arch 
(throwing out of view what happens more or less frequently, that some 
are given off by this latter alone) and the dorsal arch of the carpua 
contribute to produce them ; so that the obliteration of one of these 
sources may be easily replaced by the enlargement of the other. 

Each finger receives at least four constant branches, two palmar 
and two dorsal ; the latter are smaller than the others. The two 
palmar branches anastomose on the palmar side, either on one phalanx 
only, or on several, or even on all, by one or more transverse branches, 
the convexity of which is turned a little forward. However, among 
these anastomosing branches, the only ones which are constant are 
those which are very much developed on the lower face of the third 
phalanx and which are usually double. Besides, the palmar branches 
anastomose with the dorsal by an arch on the back of the phalanges, 
especially the third. Each palmar artery gives off in its course at least 
ten or twelve branche?, which go to the nerves, tendons, ligaments, and 
skin. It also gives, from the arch it forms at the extremity of the finger, 



ANGEIOLOGY. 287 

by anastomosing with that of the opposite side, at least as many ramue- 
cules, which go to to the skin. 



CHAPTER III. 

THORACIC PORTION OF THE AORTA. 

§ 1438. From the thoracic portion of the aorta or from the pectoral 
aorta (aorta thoracica) (§ 1329) arise numerous but very small arteries, 
and hence the aorta after giving them off is not sensibly smaller than 
when proceeding along the chest after the three trunks have arisen 
from its arch. 

Many of these branches are constant, but others are not ; and they 
frequently arise totally or at least in part from other arteries. 

The former arise from the lateral parts or from the posterior side of 
the pectoral aorta in its whole length ; the others come principally from 
its upper and central part and from its anterior side. 

A. ANTERIOR BRANCHES. 

§ 1439. The anterior branches of the thoracic artery are principally 
the inferior bronchial (Jl. inferiores bronchioles)^ the esophageal (Jl. 
esophageal), and the posterior mediastinal arteries (Jl. mediastinales pos- 
terior es). 

The inferior bronchial arteries which arise from the aorta vary much 
in number and origin. 

They vary in number from two to four. There are commonly two 
on each side for each bronchia. The inferior are a little larger than the 
superior. The largest and most constant generally arise an inch below 
the extremity of the arch of the aorta. The right is almost always a 
branch from the first intercostal artery of the aorta, which gives it off 
after coming on the right side of the vertebral column, passing behind 
the esophagus. But sometimes it arises directly from the aorta, and 
the latter frequently gives off on the right a second inferior bronchial 
artery when the usual one arises from the first intercostal branch of the 
aorta, or even when the left bronchial artery sends ramifications to the 
right bronchia. The left, on the contrary, arises directly from the aorta, 
and passes before the esophagus to go to its bronchia ; but as it is larger 
than that on the right side, it commonly gives also some branches to 
the bronchia of the right side. 

The small superior bronchial arteries, which are less considerable and 
inconstant, belong generally speaking more to the left than to the right 
bronchia. 

Besides these ramuscules, which may be called the middle bronchial 
arteries, each bronchia receives from the subclavian artery (§ 1372) or 
from the corresponding internal mammary (§ 1398), branches, called 



288 DESCRIPTIVE ANATOMY. 

the superior bronchial arteries, which are expanded in its upper part 
and communicate by large anastomoses with the middle and inferior 
bronchial arteries. 

Sometimes the aorta gives off only one bronchial artery, which often 
arises from it in common with the right superior intercostal artery. 

The bronchial arteries are distributed not only to the bronchioe but 
also in the esophagus, the aorta, the pericardium, and the thymous 
gland. 

§ 1440. The aorta gives off, generally below these arteries, from its 
anterior part, several esophageal arteries, which vary in number from 
two to seven and which are always smaller than the bronchial arteries. 
These arteries communicate with the esophageal branches which arise 
from the bronchial arteries and also with others, which are given off 
by the inferior diaphragmatic arteries, with the latter, and with the arte- 
ries of the stomach. They anastomose extensively and always by 
very large branches. 

1441. The posterior mediastinal arteries are always small and very 
numerous. They are distributed partly in the esophagus and particu- 
larly in the parietes of the thoracic aorta, and anastomose with each 
other, and also with the esophageal arteries, and with the branches 
of the internal mammary artery. 

B. LATERAL AND POSTERIOR BRANCHES. INTERCOSTAL ARTERIES. 

§ 1442. The inferior and posterior aortic intercostal arteries {A, 
intercostales posteriores, inferiores, s. aorticce) are the lateral and 
the posterior branches of the thoracic aorta. We find an arterial branch 
in each intercostal space, but the aorta does not give off as many as 
there are spaces ; for, 1st, the first and second, or at least the first, 
usually receive their vessels from the superior intercostal artery, a branch 
of the subclavian artery (§ 1399). 

2d. Several intercostal arteries, particularly the upper and the lower, 
and sometimes also the middle, although then the upper and lower do 
not participate in the anomaly, arise by common trunks, both the oppo- 
site arteries of the right and left sides, which correspond in respect to 
the intercostal space into which they penetrate, as well as those which 
are situated one above the other on the same side. This last anomaly 
is more rare than the first. When two intercostal arteries arise by a 
common trunk, we have always observed hitherto that the inferior is 
the continuation of the trunk and proceeds in its direction, while -the 
superior generally passes before and more rarely behind the neck of the 
rib to arrive at the intercostal space, in which it is then distributed as 
usual. 

A common trunk usually divides only into two secondary branches, 
but sometimes also it gives off several, of which the superior aortic 
intercostal artery(l) gives frequent examples. 

(1) In opposition to the superior intercostal, which arises from the subclavian artery, 



ANGE1OL0GY. 289 

The fact that the superior and inferior intercostal arteries generally 
arise by a common trunk, is curious in two respects : 

1st. Because it furnishes a new instance of the resemblance between 
the upper and the lower extremities of the same region. 

2d. Because the superior aortic intercostal artery and the superior 
intercostal which arises from the subclavian artery, especially corre- 
spond. 

The two arrangements are then a repetition, in the central portion 
of the vascular system, of the resemblance demonstrated between the 
uppsr and the lower part of this system, when we consider the dia- 
phragm as the line of demarkation between the two portions. 

Finally, the two series of intercostal arteries are not perfectly similar, 
and the two intercostal spaces of one side frequently receive their 
is from a common trunk while on the other side they arise sepa- 
rately^ 1) 

We generally find on each side eight(2) aortic intercostal arteries 
because the upper intercostal artery gives them to the first two inter- 
costal spaces, and the third and fourth receive the blood from the 
branches of the first aortic intercostal artery. 

The number of the intercostal arteries is very rarely increased by 
one, which happens when the upper intercostal artery, usually furnished 
by the subclavian, arises directly from the pectoral aorta. (3) This is 
more frequently the case than that the first aortic intercostal artery 
is distributed only in the third intercostal space. 

The number of these arteries is then one less, and is reduced to 
seven. Then sometimes the first goes to the second, third, and fourth 
intercostal spaces ; sometimes, and more frequently, two of the inferior 
arise by the same trunk. 

All the intercostal arteries generally come more from the back side of 
the aorta than from its lateral part, they arise near each other, and 
the right and the left at the same height. 

They are all detached from the aorta at. slightly acute angles, and 
go upward toward the intercostal space to which they correspond, 
passing on the bodies of the vertebrae and the necks of the lower ribs. 

The distance between their origin and their intercostal space is 
much greater, and the angle which they make with the trunk is more 
acute above and more obtuse below in the upper than in the lower. 
They never, not even the lowest, form a right angle with the aorta. 

(1) Bichat is mistaken in saying that, considered on the two sides, these arteries 
are almost perfectly similar (An. descript. vol. iv. p. 253). 

(2) Bichat asserts erroneously, that there arc usually nine. Murray and Scem- 
merring are also mistaken in saying- there are never less than eight. Mayer 
i3 still more in the wrong; he admits that there are usually eleven aortic intercostal 
arteries on the right side, and ten on the left. 

(3) Monro seems to regard this formation as equally common with the rule (Out- 
/incs, p. 322); but it is in fact very rare, a circumstance which is not uninteresting, 
inasmuch as the pectoral aorta seems to have, directly above the origin of the inter- 
costal artery, a great tendency to contract very much or to close entirely. 

Vol. II. 37 



290 DESCRIPTIVE ANATOMY. 

These arteries become smaller in proportion as they are lower. It 
is however necessary to say something more exact on this subject. In 
fact the first intercostal artery is. much larger than the others, partly 
because it is distributed to a greater number of intercostal spaces, and 
because on the right side at least it gives rise either partly or wholly to 
the right bronchial artery. 

The right intercostal arteries, from the situation of the aorta on the 
left side of the vertebral column, arc longer than the left, by all the 
right portion of the vertebra on which they pass. 

Near their origin they give ramifications to the esophagus and 
generally to all the parts contained in the posterior mediastinum, and 
divide usually near the head of the ribs into two branches, a posterior 
and an anterior. 

The posterior branch (JR. posterior, s. dorsalis) passes through the 
intercostal space to go backward, gives some ramuscules to the verte- 
bra, also sends some to the spinal marrow, through the intervertebral 
foramina, but is distributed principally to the posterior muscles of the 
trunk situated in' the groove between the vertebral column and the 
ribs, the multifidus spinas and the longissimus dorsi. Its superficial 
ramifications reach even to the skin, and it anastomoses by ascending 
and descending branches with the adjacent superior and inferior dorsal 
branches. 

The anterior, thoracic, or intercostal branch (R. anterior, thoracicus, 
intercostalis) is generally much larger than the dorsal, which exceeds 
it particularly in volume in the superior intercostal arteries, and 
which, from its direction, may be considered as the continuation of the 
trunk ; it proceeds first between the pleura and the posterior part of the 
intercostalis internus muscle, to which it is feebly united, then passes 
between the intercostales interni and externi muscles, and soon di- 
vides into two branches. 

The inferior branch (R. coslalis inferior) is much smaller than the 
other, goes forward, along the upper edge of the lower rib, soon passes 
on the internal face of this bone, gives ramifications to its periosteum, 
furnishes some, although very few, to the intercostales muscles, and 
terminates by anastomosing with the upper branches of its trunk and 
of the intercostal artery which come directly after. 

The upper branch (R. coslalis superior) is the continuation of the 
trunk, and proceeds below the upper rib of its intercostal space in the 
groove, on its lower edge, goes forward, gives ramuscules to the ribs, 
to the intercostales, the abdominal, and the dorsal muscles and to the 
diaphragm, and anastomoses with the anterior intercostal arteries 
which come from the internal mammary artery, and also with the 
epigastric and the external iliac arteries. 

The first intercostal artery is distinguished from the others by the 
characters we have already mentioned. It supplies several, and 
sometimes even three intercostal spaces. 



ANGEIOLOGY. 291 

The right and left differ, as the first usually gives off the right 
bronchial artery while the second is distributed more frequently than 
it in a third intercostal space. 

Although this latter arrangement is not constant, we have never 
seen the first two intercostal arteries correspond in regard to the 
former.(l) 

Next to the first the last is largest of any, and sometimes exceeds it 
in size. It arises behind the lumbar portion of the diaphragm ; after 
giving some branches to this muscle it passes almost entirely below 
and before it, and, proceeding outward and forward, behind the upper 
portion of the quadratus lumborum muscle, it divides into several large 
branches, which are distributed in this muscle and also the broad 
muscles of the abdomen, then descend to the crest of the ilium, and 
anastomose frequently with the lumbar and with the circumflex iliac 
arteries. 

The two inferior intercostal arteries often arise by a single trunk, 
which comes from the posterior part of the aorta. They are some- 
times deficient on one or on both sides ; they are then replaced by 
the first lumbar arteiy. 



CHAPTER IV. 

ABDOMINAL PORTION OF THE AORTA. 

§ 1443. The abdominal aorta gives off in fact fewerbranches, but 
most of them are larger than those which arise from the thoracic 
aorta. The reason of this is that the abdomen is larger than the chest, 
and the organs which it contains are also much larger. A farther 
reason is that all these organs receive their arteries from the abdominal 
aorta, while those of the thoracic viscera do not all come from the 
thoracic aorta. 

The branches of the abdominal aorta may be divided into anterior, 
lateral, and posterior. The anterior and the posterior are however, at 
least in great part, sometimes more and sometimes less lateral than 
usual. 

I. ANTERIOR BRANCHES. 

§ 1444. The anterior branches of the abdominal aorta belong 
almost exclusively to the digestive organs. There are usually three, 
the cozliac, the superior, and the inferior mesenteric arteries. Some- 

(1) As Scemmerring seems to admit (p. 249), since he thinks that the first two inter- 
costal arteries arc large because they give off the bronchial arteries. Bichat agrees 
with us (p. 250) on this subject. 



292 DES* RIPTIVE ANATOMY. 

times however we find only two, the first two arising by a common 
trunk. But they oftener exceed three. 

The aorta on coming into the abdomen, having passed thiough its 
opening in the diaphragm, usually gives some small branches to the 
pillars of this muscle, to the thoracic canal, and to the renal capsules. 

It seldom gives off the inferior diaphragmatic arteries, either sepa- 
rately or by a common trunk. These arteries more frequently arise 
from the coeliac artery, consequently they will be treated of when 
speaking of that artery.(l) 

I. CCELIAC ARTERY. 

§ 1445. The coeliac artery, Opislrogastrique, Ch. (Ji. cceliaca),(2) 
is usually the largest, and arises the highest, as it comes off at a right 
angle from the aorta, between the pillars of the diaphragm. 

Usually and in fact almost always, when its trunk is not exceed- 
ingly short, it gives off first, from its upper side, the superior dia- 
phragmatic arteries (A. diaphragmatic a?, s. phrenicce majores, s. prin- 
cipes, s. inferiores), which arise sometimes separately and sometimes 
by a very short common trunk. Sometimes one of these arteries comes 
from the aorta and the other from the cceliac artery ; more rarely one 
or both of them are given off by one of the branches of the cceliac, or 
even by the renal, or finally by the inferior capsular artery. They 
ascend directly on the pillars of the diaphragm, to which they give off 
branches, and also supply the middle capsular arteries (A. suprare- 
nales met/ice), which go to the renal capsules ; and when they have 
arrived at the upper extremity of the pillars, divide into an anterior 
and a posterior branch. 

The posterior branch, which is the smaller, is sometimes, at least 
on one side, given off wholly or partially by the aorta. Even when 
the principal trunk arises from the coeliac artery, it sends considerable 
branches to the renal capsules ; these are called the superior capsular 
arteries (A. suprarenales superiores). It then goes outward, below 
and behind the tendinous centre of the diaphragm, to be distributed 
principally in the lumbar portion of this muscle. 

The anterior branch is much larger, and must be considered as the 
continuation of the trunk ; it goes forward, along the esophagoeal 
opening, before which it divides into two branches, an anterior and 
internal, and transverse which is much smaller, and is distributed to 
the central portion of the diaphragm, and anastomoses with that of the 

(1} Monro is mistaken in saying- that these arteries ari=c from the aorta (vol iii 
p. 333). Mayer (p. 656) also seems to think this is the most common arrangement' 
Murray (p. 61) and Scemmerrin? (p. 252) think that they arise from the aorta as fre- 
quently as from the cceliac artery. Bichat is more correct (p. 283) in saying- that 
they arise from the cceliac artery more frequently than from the aorta. This remark 
was made long- before him by Haller (part. 2, notes to vol. i. p. 6). 

(2) A. F. ^Valther, Dc arlcriii cceliacis, Leipsic, 1729. 



ANGEIOI.OCY. 293 

opposite side, while the external is much larger, goes outward, and 
gives ramuscules to most of the costal portion of the diaphragm. 

The inferior diaphragmatic arteries go principally to the lower face 
of the central portion of the diaphragm. They communicate with the 
external which arise from the internal mammary, with the inferior inter- 
costal, and the lumbar arteries ; also pass through the diaphragm, 
enter the chest, and give off, in this cavity, the pericardiac and the 
inferior mediastinal arteries. 

§ 1446. The cceliac trunk after and sometimes also before giving 
off the inferior diaphragmatic arteries divides most generally into three 
branches ; these are the coronary arteries of the stomach, the hepatic 
and the splenic artery. These three branches form the tripus Halleri. 

§ 1447. The coronary artery of the stomach, Stomogastrique, Ch. 
{Ji. coronaria ventriculi, s. gastrica superior, major sinistra, gastro- 
hepatica sinistra), is usually much smaller than the other two branches 
of the cceliac artery. Sometimes, but rarely, it arises from the aorta 
before the latter, either alone or by a trunk which is common with it, 
sometimes with only one of the inferior diaphragmatic arteries, parti- 
cularly that of the left side, and sometimes with both. 

It proceeds first upward and forward, then to the left, and gives off, 

1st. Several inferior esophageal arteries (A. esophageal inferiores). 

2d. Several posterior cardiac arteries (A. cardiacoz posteriores), 
which are distributed around the superior orifice and on the large 
curvature of the stomach, and descend principally on its posterior face. 

3d. Very frequently, and even almost always, the left hepatic 
artery.(l) 

The anterior and superior gastric and the other inferior esophagceal 
arteries, arise from this artery or from the following branch. 

4th. The gastric branch (R. gastricus). When the coronary artery 
of the stomach gives off the left hepatic artery, it bifurcates to give 
origin to it and also to the gastric branch. The latter usually divides 
into several large anterior and posterior ramuscules, which are distri- 
buted on the anterior and posterior faces of the stomach, and anasto- 
mose with each other and with the preceding. It always gives off a 
greater or less anastomosing branch, which follows the small curve of 
the stomach, and goes toward the right side, where it anastomoses 
with the pyloric artery. 

§ 1448. The hepatic artery (Jl. hepatica) is larger than the preceding 
Sometimes it does not give off the usual number of branches. The 
anomaly may then occur in several different ways. In fact the 
hepatic artery is sometimes divided into two trunks, which arise one 
from the cceliac artery as usual, the other from the coronary artery of 
the stomach, or from the superior mesenteric artery, or more rarely from 

(1) Hence the term gastro-hepatic which has been applied to it. In this case the 
coronary artery of the stomach is not, as g-crierally, much smaller than the other two 
branches of the cceliac artery, but it is often as large as the hepatic, especially 
when it gives off at the same lime one or both of the inferior diaphragmatic arteries. 



294 DESCRIPTIVE ANATOMY. 

the aorta ; sometimes there are three trunks, one of which arises from 
the coeliac, a second from the superior mesenteric artery, a third from 
the aorta. 

Sometimes but more rarely the hepatic artery arises entirely from 
the aorta. The rarest anomaly is that where it comes entirely from 
the superior mesenteric artery.(l) 

The trunk of the hepatic artery proceeds transversely to the right 
side ; it then goes a little obliquely forward and upward, entering into 
the transverse fissure of the liver. 

Just before arriving at the liver it divides into two branches, the 
right gastroepiploic artery and the hepatic branch. 

§ 1449. The right gastroepiploic artery {Jl. gastrica dextra infe- 
rior, coronaria ventriculi dextra inferior, gastro-epiploica dextra pan- 
creatico-duodenalis), which is much smaller when only one hepatic 
trunk exists, but which in other cases is as large as the hepatic branch, 
goes downward, and to the left, toward the origin of the duodenum, 
passes below this intestine, between it, the pylorus, and the pancreas, 
reaches the great curvature of the stomach, proceeds along it from 
right to left, and anastomoses with the left inferior gastroepiploic 
artery. 

In its course it gives off the following branches : 

1st. Before arriving at the duodenum and passing under this intes- 
tine, one or two considerable branches, the pancrealico-duodenal arte- 
ries {Jl. pancreatico-duodenales), which descend along the concavity of 
the duodenum, give to it numerous ramuscules, and also give origin to 
one or two retrograde pyloric arteries {Jl. pyloric ce inferiores) ; the latter, 
which are distributed around the pylorus, give off other considerable 
branches to the head and to the right portion of the pancreas, and 
anastomose extensively with the branches of the superior mesenteric 
artery. 

One or more of these anastomosing branches are sometimes so large 
that we might consider the right gastroepiploic artery rather as a 
branch of the inferior mesenteric than as arising from the coeliac artery. 

2d. The continuation of the trunk proceeds along the large curva- 
ture of the stomach, gives a great number of ascending branches to 
the two thirds on the right of this viscus, and sends others, which are 
less numerous and which descend between the two layers of the large 
epiploon, where they form the right and middle epiploic arteries {Jl. 
epiploicce. dextra et medice). These branches anastomose with each 
other and with those of the left gastro-epiploic artery by large arches. 

Near the commencement of the left third of the stomach the trunk 
of the right gastro-epiploic artery gradually diminishes and becomes 
very small, so that we can easily perceive the limit which separates it 
from the left gastro-epiploic artery, with which it anastomoses in this 
place. 

(1) Haller, Ic. anal., part viii. p. 36. 



ANGEIOLOGY. 295 

§ 1450. From the hepatic branch (R. hepaticus), sometimes also 
from the trunk of the hepatic artery, before it gives off the right gastro- 
epiploic artery, arises a smaller branch, called the superior pyloric 
artery (A. gaslrica dextra superior, coronaria ventriculi dextra superior, 
pylorica superior). This branch descends towards the pylorus and 
anastomoses with the inferior pyloric, and with the branches of the 
left gastro-epiploic by small arches. 

Soon after the hepatic branch divides into a right and left. 
The right hepatic artery (A. hepatica dextra) is larger than the left. 
It is distributed to the right lobe of the liver and to the gall-bladder. 

This soon divides into two branches ; the smaller goes to the middle 
part of the liver (A. hepatica dextra minor, A. hepatica media) ; this 
sometimes arises directly from the aorta, although the origins of all 
the other branches are normal ; the other is greater and is the continu- 
ation of the trunk. The latter goes to the vena-porta, enters the trans- 
verse fissure of the liver, where it divides into numerous ramifications, 
and almost always gives off, just before entering, one or two cystic 
arteries (A. cystica). 

The right hepatic artery, either alone or with the right gastro-epi- 
ploic artery, not unfrequently arises from the superior mesenteric 
artery, an arrangement always indicated by the large anastomoses 
between these two arteries by means of the pancreatico-duodenal 
arteries. The left hepatic artery, not unfrequently, is separated from 
the right, and arises from the tripus Halleri by a common trunk with 
the coronary artery of the stomach. 

§ 1451. The splenic artery (A. splenica, s. lienalis) is the largest of 
the three branches of the coeliac artery in the adult, and goes to the 
left soon after arising, proceeding below and behind the stomach in the 
transverse fissure of the pancreas. 
In this course it gives off, 

1st. From its lower side the middle and the left pancreatic arteries 
(A. pancreaticce medioz et sinistra^), which vessels are usually large and 
arranged in an arch ; they go from right to left on the pancreas, and 
from their convexity arise numerous anterior and posterior branches 
which penetrate from below upward into the pancreas. 

2d. More to the left, five or six short gastric arteries arise (A. gas- 
tricce breves, s. fundi ventricidi). These almost always make a part 
of the numerous branches into which the trunk of the splenic artery 
divides before entering the spleen. 

These vessels retrograde toward the left large extremity of the sto- 
mach and communicate on its two faces, by numerous anastomoses, 
with the coronary and right gastro-epiploic arteries. 

We observe a lower branch, which is large ; this is the left gastro- 
epiploic artery {A. gastrica, s. coronaria sinistra inferior, gasiro-epi- 
ploica sinistra) ; this descends along the great curvature of the sto- 
mach, usually anastomoses very evidently with the right gastro-epi- 



296 DESCRIPTIVE ANATOMY. 

ploic artery, and gives off large branches, the left epiploic arteries, to 
the large epiploon. 

II. SUPERIOR MESENTERIC ARTERV. 

§ 1452. The superior mesenteric artery (Jl. mesaraica, s. mesenterial 
superior) is generally a little and often considerably larger than the 
cceliac artery, when the latter arises partly from the aorta or from the 
superior mesenteric artery, and generally comes from the trunk of the 
aorta directly below the cceliac trunk. It not unfrequently arises with 
it by a common trunk, which is sometimes nearly an inch long,( 1 ) — a 
curious arrangement, as it resembles the formation of the tortoise. 

The artery is covered first by the pancreas, and descends perpendi- 
cularly behind it on the lower part of the duodenum. It passes between 
the two layers of the mesentery and near its centre describes a conside- 
rable curve, the convexity of which looks forward and downward to the 
left while its concavity is turned to the right backward and upward. 
The centre and upper part of this curve is much farther from the small 
intestine than its lower portion ; it gradually diminishes and terminates 
on the right and downward in the right lumbar region. 

All the constant branches of the superior mesenteric artery arise 
from this curve, which furnishes blood to a part of the pancreas, to all 
the small and most of the large intestine, especially to its right and 
transverse portions. The first branches go to the pancreas and to the 
duodenum ; the next go to the large intestine ; and the inferior to the 
small intestine. The first ansstomose with the hepatic artery, more 
rarely also with the coronary artery of the stomach. (2) 

The arteries of the small intestine (Jl. inlestinales), which come from 
the convexity of the curve of the superior mesenteric artery, deserve to 
be mentioned before the others, (3) because the first of them arises 
higher than those which come from the concavity, and the study of 
the latter naturally leads to that of the branches which come from the 
inferior mesenteric artery. 

The superior intestinal arteries are usually the longest ; the first is 
however a little shorter than the following, but the last or the lowest 
are shorter than the others and also the smallest. 

We generally number from sixteen to twenty ; but we must reduce 
this number to ten or eleven, as it is more correct to consider the lowest 
not as distinct trunks, but as secondary branches of the last branch 

(1) Haller considers this arrangement as a rare anomaly, because he has observed 
it only once; {Ic. anat., part viii. p. 35, No. 11). We however think it more com- 
mon, for we have seen it five times, although we did not look for it particularly in 
the cadavers we examined. 

(2) Barclay, loc. cit., p. 182. 

(3) This method has been followed correctly by Mayer (Ang., p. 170), and Monro 
(Outlines, p. 335); but not by Murray (p. 68), Scemmerring (p. 267), and Bichat 
(p. 267). 



ANGEIOLOGY. 297 

which in going from left to right and from below upward anastomoses 
with the last of the branches which arise from the concavity. 

if we follow the usual method, the intestinal arteries are almost al- 
ways more than twenty in number, and the last eight or nine are ex- 
tremely small and short. 

These arteries diminish from above downward in respect to their dia- 
meter ; we however find among the largest some which are very small, 
although they also arise from the trunk of the mesenteric artery. 

They all proceed between the two folds of the mesentery to the intes- 
tine, distributing in their progress numerous branches to this membrane 
and also to the mesenteric glands. They usually divide into an upper 
and a lower branch. This division occurs sooner or later, in proportion 
as the branches are shorter or longer. These branches anastomose 
with the opposite branches of the adjacent arteries and form a large 
arch, composed of as many smaller arches as there are intestinal arte- 
ries ; the convexity of this arch always looks toward the concavity of 
the small intestine. The two branches do not suddenly unite, but anas- 
tomose at a proportionally short distance from the intestinal canal. 

Numerous secondary ramifications arise from the convexity of these 
arches ; these are very compactly situated and very frequently anas- 
tomose. Hence results a much more extensive external arch, composed 
of a still greater number of small arches, whence arise numerous ter- 
nary branches. These also bifurcate two or three times, and anasto- 
mose in the same manner, at least where the intestinal arteries are 
larger. 

These vessels represent by their division a very coarse net. 

Finally, from the external surface of this net arise numerous arte- 
rioles, which are divided into an anterior and a posterior series, which 
go to the intestinal canal and are distributed on its internal membrane 
after still more subdivisions and anastomoses. 

A minute description of their distribution in the intestine will be given 
after that of the intestinal canal more properly than in this place. 

§ 1453. From the concavity of the curve of the superior mesenteric 
artery, nearly opposite the place where the third, fourth, fifth, and sixth 
intestinal arteries arise, and about an inch from each other, are con- 
stantly given off at least two, and almost as often or at least not very 
unfrequently three branches, which belong exclusively to the colon, 
particularly to its right portion; these may be called the right colic 
arteries (Jl. colicoz dextr<z). Of these branches the centre is usually 
smaller than the other two, and generally it arises nearer the superior. 

§ 1454. The lowest, which goes to the right outward and downward, 
is called the inferior right colic or the ileo-colic artery (Jl. colica inferior 
dextra, ileo-colica). Some distance from its origin it sends downward 
a branch, which anastomoses with that which we have considered as 
the last intestinal artery and which is generally regarded as the trunk 
of the superior mesenteric artery, uniting with this artery a little before 
it terminates, partly also proceeds as the artery of the cozcal appendix 

Vol. II 38 



298 DESCRIPTIVE ANATOMY 

{A.appendicalis) to the vermiform appendage of the coec urn, along which 
it reascends to its extremity, giving off from its convexity a great num- 
ber of branches, which arise at acute angles. 

It afterwards immediately divides into an ascending and a descending 
branch. 

The descending branch, the cozcal artery {JL. ccecalis), sends a large 
anastomosing ramuscule to the last intestinal artery or to the extremity 
of the curve of the superior mesenteric artery, and afterwards divides 
into two other secondary branches, the anterior and the posterior cozcal 
artery, which are distributed in the corresponding parts of the ccecum 
and anastomose with the artery of the ccecal appendix. 

The ascending or anastomosing branch (R. ascendens, s. anaslomo- 
licus) ascends at a short distance from the concave part of the intestinal 
canal along the ascending colon, to which it gives off numerous branches, 
not however equal in number to those of the intestinal arteries, which 
also anastomose less frequently. These branches divide near the colon 
into ramuscules, forming an anterior and a posterior series, all of which 
are distributed to the parietes of this intestine. 

§ 1455. The middle right colic arterjr {Jl. colica dexlramedia, colica 
dextra, colica dextra inferior) is always the smallest of the three 
branches which arise from the concavity of the curve of the mesenteric 
artery, and often comes from the superior. Sometimes but very rarely 
it is given off by the inferior right colic artery.(l) It usually com- 
mences very near the superior colic artery. 

When it is given off by the latter, it generally arises at the place 
where it anastomoses, when it comes from the mesenteiic artery, with 
the superior colic artery by a short but very large branch ; so that when 
it forms a distinct trunk we should consider it as an anastomosing 
branch between the superior right colic artery and the trunk of the 
superior mesenteric artery. 

When it is a branch of" the superior mesenteric artery, it divides some 
distance from its origin into a superior and an inferior branch. 

The superior ascending branch is much shorter and anastomoses 
with a similar branch from the superior right colic artery. 

The inferior descending branch is much larger, goes along the con- 
cavity of the ascending colon, and anastomoses by a large arch with 
the ascending branch of the inferior right colic artery. 

This artery supplies the middle part of the ascending colon with 
blood. 

§ 1456. The superior right colic artery {Jl. colica superior dextra, 
colica media, s. anastomotica dextra) generally arises some inches below 

(1) Bichat seems to doubt this fact, but wrongly. He says that the inferior colic 
artery is constantly distinct. Murray and Mayer do not mention it, althoue;h thev 
very correctly state that the two superior right colic arteries not unfrequently form 
one trunk, babatier and Scemmernng are more correct in saying that the two infe- 
rior right colic arteries rarely arise together. Others, as Portal and Monro, mention 
only the case3 where th e three arteries form three distinct trunks 



ANGEIOLOGV. 299 

the origin of the trunk and as high as the transverse mesocolon. It 
afterward enters between the two layers of the peritoneum, goes directly 
forward toward the centre of the transverse colon, and divides into a 
right and a left branch. 

The right branch is generally a little smaller than the other, is also 
shorter, and anastomoses with the ascending branch of the middle right 
colic artery, which it sometimes replaces entirely (§ 1455). 

The left branch (R. anaslomoticus magnus) passes behind the left and 
largest portion of the transverse colon, communicates with the ascending 
branch of the left colic artery given off by the inferior mesenteric artery, 
and forms with it the largest anastomosis found in the adult. This 
anastomosis is seldom deficient. 

This artery is distributed to the upper part, of the ascending, and to 
the central and right portions of the transverse colon. 

§ 1457. One branch of the superior mesenteric artery, which exists 
only in the early periods of life, is the omphalo-mcsenleric artery (Jl. 
omphalo-mesaraica), which generally arises from this trunk, but in no 
determinate place ; this artery, accompanied by the veins of the same 
name, leaves the mesentery, passes on the lower part of the small in- 
testine, arrives at the umbilicus, comes from the abdomen with the 
intestine, enters into the umbilical sheath before the end of the second 
month of pregnancy, and extends to the umbilical vesicle, and distri- 
butes its ramifications on its surface. This branch constantly exists 
until the end of the second month, after which it is almost always ob- 
literated and is visible only in the mesentery and near the umbilicus. 
Sometimes it continues, always preserving rather a large caliber, and 
extends with its accompanying vein to the umbilical ring or even into 
the cord. Sometimes it is obliterated, but extends from the intestine to 
the umbilicus. These two cases occur principally when the intestinal 
canal, either alone or with other organs, is'arrested at one of the first 
degrees through which it passes successively in its formation. The om- 
phalo-mesenteric artery is undoubtedly the largest of those in the fetus. 

III. INFERIOR MESENTERIC ARTERY. 

§ 1458. The inferior mesenteric artery (Jl. mesaraica, s. mesenterica 
inferior) comes from the aorta, generally some inches lower than the 
preceding, and usually about an inch above the bifurcation of the trunk 
of the aorta where the two primitive iliac arteries arise. 

The only exceptions are when several renal arteries existing, one of 
them arises very low and the mesenteric artery is constantly given off 
from the aorta above the latter ; its description however should precede 
theirs, because it comes from the anterior part of the trunk of the aorta, 
and because it is distributed to the intestinal canal, as are all the other 
arteries which arise in like manner from the anterior side of the abdo- 
minal aorta 



300 DESCRIPTIVE ANATOMV 

Still more rarely it comes from the primitive iliac artery,(l) which 
happens when the aorta bifurcates higher than usual. 

It is always a little smaller than the renal arteries, proceeds obliquely 
to the left and upward under the peritoneum, penetrates immediately 
between the layers of the iliac meso-colon, and divides into several 
branches, which belong only to the left portion of the colon and to the 
rectum, the upper of which may be called the left colic arteries (.#. co- 
lk(z sinistral), to distinguish them from the right (§ 1456) which arise 
from the superior mesenteric artery, while the lower go to the rectum 
and are called the upper hemorrhoidal arteries (d. hemorrhoideoz supe- 
rior es). 

This artery is rarely deficient(2), a remarkable anomaly, which 
resembles the normal formation of many animals, viz. birds and reptiles, 
in which the posterior mesenteric artery gradually diminishes and en- 
tirely disappears. 

§ 1459. The left colic arteries (Jl. colicai sinistral) arise from the 
upper convex part of the inferior mesenteric artery. We sometimes 
find two or three, a superior, middle, and an inferior. The middle is 
sometimes blended with the superior and sometimes with the inferior. 
The first case is more common. 

The superior left colic artery (Jl. colica sinistra superior, anastomotic a 
sinistra), generally the larger, proceeds along the descending colon 
and divides into two branches. This division occurs sometimes imme- 
diately, when it gives off the middle colic artery, sometimes later, when 
this arises separately from the mesenteric artery or by a common trunk 
with the inferior. 

In the second case one branch goes to the right, the other to the 
left side. The latter anastomoses with the left branch of the superior 
right mesenteric artery, behind the left portion of the transverse colon, 
and thus forms a large arch (arcus anaslomolicus magnus), (§ 1456) 
to produce which however it but slightly contributes. This anasto- 
moses, in front of the upper part of the descending colon, with the 
ascending branch of the middle left colic artery. 

The middle left colic artery (Jl. colica sinistra media) sometimes forms 
the lower branch of the preceding ; and then arises from it very early, 
but more frequently is a distinct trunk, which soon after divides into two 
branches, the larger of which ascends along the left colon, and anas- 
tomoses with the descending branch of the superior left colic artery ; 
and the inferior communicates with the ascending branch of the infe- 
rior left colic artery. 

The inferior left colic artery (Jl. colica sinistra inferior), which is 
distributed to the lower part of the descending colon, divides si ill sooner 
into two branches, which anastomose, the ascending with the descend- 
ing branch of the middle left colic artery, and the descending with the 
ascending branch of the superior hemorrhoidal artery. 

(1) PetsHio, Syll. oh*.-, in Waller, ( 'nil. diss., vol. vi. p. 761. 

(2) Fleischmann, Lekhenbffnungen, 1815, p. 239. 



ANGEIOLOGV, 301 

§ 1460. The superior hemorrhoidal artery (A. hemorrhoidea supe- 
rior, s. interna) arises from the concavity of the curve described by the 
inferior mesenteric artery. It would then be more correct to consider 
it as the inferior of the two branches, into which this artery often 
divides, and the upper of which furnishes the left colic arteries. 

It goes to the right, and descends behind the rectum, distributing 
its branches to most of this intestine. It usually divides into two 
branches, the upper of which is smaller, and the lower larger, and is 
the continuation of the trunk. Each branch immediately divides, 
although at some distance from the rectum, into a right and left, 
which open together downward and beside each other by considerable 
anastomoses, and are distributed to the rectum, where their branches 
usually communicate with those of the vesical and uterine arteries. 

We shall mention the difference in the arrangement of the arteries 
of the small, and those of the large, intestine, when treating of the 
intestinal canal. 

II. LATERAL BRANCHES. 

§ 1461. The lateral branches of the abdominal aorta are the middle 
capsidar, the renal, and the spermatic arteries. 

I. MIDDLE CAPSULAR ARTERIES. 

§ 1462. The middle capsular arteries (A. capstdares mcdias) are 
one, two, and sometimes even three, in number, and arise from the 
aorta very near each other, usually above, sometimes below, and a 
little in front of the renal arteries. In some subjects they come from 
the cceliac or from the renal arteries. They go to the right and left, 
passing on the bodies of the vertebrae, and arrive from below upward 
on the posterior face of the renal capsules, but at the same time they 
send branches to the pillars of the diaphragm, and to the lymphatic 
glands in the lumbar region. 

II. RENAL ARTERIES. 

§ 1463. The renal or emulgent arteries («#. renaless. emulgentes) come 
entirely from the side of the aorta, directly below the superior mesenteric 
artery. They arise at a right or at an almost right angle ; they pro- 
ceed from before backward and from within outward, directly on the 
lateral faces of the bodies of the first or second lumbar vertebra, and, 
arrived at the kidney, penetrate into its fissure after dividing, most fre- 
quently near this organ, into several and generally into three branches, 
which also subdivide before entering its substance. 

They arise almost opposite each other ; the right however is a little 
lower than the left, because the kidney of this side is lower than that 
of the other. To this law however there are exceptions. We remark 



302 DESCRIPTIVE ANATOMV 

particularly that when the right renal artery is double, the superior 
usually arises a little higher than the single renal artery of the left 
side. 

These arteries are very large, but not, as Bichat says, the largest in 
the abdomen, since they are smaller than the cceliac or the superior 
mesenteric artery. 

§ 1464. The renal arteries present many anomalies. The most 
usual affect their number. We generally find only one renal artery 
on each side. This number however is frequently, in fact often, 
increased by reducing the branches into distinct trunks, which arise 
directly from the aorta. The transition to this arrangement is marked 
by that where the single renal artery early divides into branches : this 
early division is not (infrequent, and often occurs only on one side ; the 
renal artery of the opposite side being already divided into several 
separate trunks. 

This anomaly of the renal. arteries differs, 

1st. In the conditions of its occurrence; 2d, in the number of divi- 
sions it produces ; 3d, in its occurrence on one or both sides ; 4th, in 
its being more frequent on one side than on the other ; 5th, in the pro- 
portional size of the separate trunks ; 6th, in their place of origin ; 7th, 
in their insertion ; 8th, in their relation with the renal veins. 

1st. The conditions in which the number of the renal arteries is 
increased are, 

a. An unusual size of the kidneys. 

b. Their unusual length, although their size is not much increased. 
In this case their central portion is often strangulated. 

c. The union of the two kidneys. 

d. Their unusually low situation in the pelvis. 

2d. In respect to number. The renal arteries are increased by one 
more commonly than by many. 

Sometimes however there are three, four, and even five on one 
side. 

3d. In regard to the simultaneous existence of several renal arteries 
on both sides at once, we remark generally that when there are not 
more than two, the anomaly occurs on one side as frequently as on 
both. When however this increase is more than two, it is rarely con- 
fined to a single side, although it very seldom occurs on both sides in 
the same degree. This rule however is not general, since four renal 
arteries sometimes exist on one side and only one on the other. 

4th. The anomaly does not seem to affect one side of the body 
more than the other. This remark is the result of our own observa- 
tions ; it however is confirmed by the difference in the assertion of 
authors on this subject. Some say that the anomaly is more fre- 
quent on the left and others on the right side. 

5th. The anomaly is the least possible when one of the two renal 
arteries is much smaller than the other. The larger then is generally 
but not always the -upper; it forms the normal trunk. In fact the 



ANGEIOLOGY. 303 

supernumerary renal wteries not unfrequently have the same caliber, 
each of them, considered separately, being a little smaller than the 
normal artery, except when one kidney is larger than the other. 

6th. The supernumerary renal arteries also vary much in their 
origins. The nearest to the normal formation is where the second 
renal artery arises directly at the side of the normal artery ; but they 
are frequently very distant from each other, so that one or some of 
them not only arise from the aorta, below the inferior mesenteric 
artery, but also come from the primitive iliac or even from the hypo- 
gastric artery ; the last two cases however usually occur only when 
the kidneys are blended together or are situated very low. But if we 
except those cases where the kidney is situated very low, one renal 
artery generally arises from the usual place, however remote may be 
the origin of the others. 

When more than two renal arteries exist, one generally arises very 
far from the rest. Sometimes they are situated at equal distances 
from each other. Sometimes also when four occur two of them arise 
very high, and two very low. 

7th. The place of insertion is more abnormal, the lower the origin 
of the renal arteries, and the greater the anomaly in the form and situ- 
ation of the kidneys. If the arteries are given off very low, although 
the situation of the kidneys is normal, they frequently do not enter its 
fissure, but are inserted at its lower extremity. If the kidney is situ- 
ated very low, the vessels usually converge from all 'sides to enter it. 

8th. The relation between the renal arteries on one side, and the 
cmulgent veins and the vena-cava on the other, may be regarded in 
two points of view : 

1st. In regard to their simultaneousness and frequency. A series 
of careful observations permit us to establish as a principle that the 
veins divide much more rarely than the arteries, and consequently 
the veins are not always abnormal, in this respect, when the arteries 
are, although this is somewhat common, even when the arteries exist, 
in regard to these two orders of vessels at the same time ; the number 
of renal arteries nevertheless frequently exceeds that of the emulgent 
veins, although sometimes, but rarely, the veins alone are abnormal. 

2d. Usually, particularly when more than two renal arteries exist, 
the relation of the situation with the veins is changed in this respect, 
that one or both of them pass before and not behind the vena-cava 
inferior to go to the kidney. One easily perceives that this rule can 
apply only to the renal arteries of the right side. 

The two renal arteries much more rarely arise from the anterior 
face of the aorta by a common trunk which, in the only case of this 
anomaly known to us, was inserted very near the mesenteric artery. 

Other anomalies relate to the side of the vascular system whence 
the renal vessels arise. Each renal artery generally goes to the kidney 
of the same side. The only exception to this rule is when 
the kidneys exist in the pelvis ; one of the renal arteries then not 



304 DESCRIPTIVE ANATOMY. 

unfrequently arises from the primitive iliac, or from the hypogastric 
artery of the opposite side. 

§ 1465. Beside these slight and inconstant differences between the 
renal arteries of the two sides, in respect to the height at which they 
arise, they are constantly distinguished from each other by their 
length ; that of the right side being longer than the other, and more 
so because the aorta is situated more to the left. In its course to the 
kidneys it usually passes behind, but not unfrequently before the 
ascending vena-cava. 

The renal arteries belong particularly to the kidneys and enter 
almost wholly into the fissure. Proceeding however they always 
give several greater or less branches. These are, 

1st. The inferior capsular artery (A. suprarenalis inferior) almost 
constantly arises from the renal artery, or at least comes very rarely 
from the aorta itself with the middle capsular arteries. This artery is 
even sometimes double, since, beside the usual artery, that which 
directly arises from the origin of the renal artery, a smaller one exists, 
which comes from one of its branches. 

This inferior capsular artery is not unfrequently very large. In this 
case it gives off branches to the lumbar portion of the diaphragm, and 
sometimes the whole inferior diaphragmatic artery comes from it. 

2d. The branches which go to the pelves of the kidneys and to the 
ureters. 

3d. Rarely, and most generally on the left, and even then usually 
only where several renal arteries exist, the spermatic artery, which in 
this case constantly arises from the inferior renal artery. We have 
however satisfied ourselves that when the renal artery divides into 
several branches, the spermatic artery is by no means always inserted 
in one of the latter. 

4th. Some branches to the renal capsule. These ramifications enter 
into the substance of the kidney, and there are likewise some small 
branches which go from the substance of the kidney to the capsule. 

5th. More rarely the right renal artery sends a branch to the lower 
part of the liver. 

III. SPERMATIC ARTERIES. 

§ 1466. The spermatic arteries {A. seminales, s. spermaticce) are 
usually single but not unfrequently double. They generally arise a 
little but sometimes far above the renal artery. They rarely originate 
opposite each other ; one is frequently detached much higher than the 
other and much more before it, and most generally before the middle 
capsular arteries, making with the aorta an acute angle. Frequently 
also the spermatic artery on one side (§ 1464) arises from the renal, 
or from the inferior or middle capsular artery. More rarely it arises 
from the lumbar, from the external iliac, from the hypogastric, or even 
from the epigastric artery of its side. It generally extends vertically 



ANGEIOLOGV. 305 

downward, but sometimes also it turns on the renal vessels before as- 
suming its downward and outward direction, which it follows and keeps 
it directly behind the peritoneum, and before the ureter, which it crosses. 
That of the right side also passes before the vena cava inferior. 

The spermatic artery is much shorter in the female than in the male, 
since it does not leave the abdomen, and is distributed to the ovaries, 
and also to the Fallopian tubes, to the round ligaments, and to the upper 
part of the uterus, communicating with the uterine arteries by nume- 
rous anastomoses. 

In the male on the contrary it leaves the abdomen through the in- 
guinal ring, forms with its corresponding vein and the lower part of the 
vas deferens the spermatic cord, gives branches to the common mem- 
brane of the cord and testicle, and is distributed principally in the latter 
organ. 

In its course it gives upward branches to the duodenum, the liver, 
the transverse meso-colon, the renal capsules, the lymphatic glands 
in the lumbar region, and to the ureter, and frequently anastomoses with 
the branches of the mesenteric and lumbar arteries. 

III. POSTERIOR BRANCHES. LUMBAR ARTERIES. 

§ 1467. The lumbar arteries (Jl. lumbales) are the posterior rather 
than the lateral branches of the abdominal aorta, since they usually 
arise nearer the centre of the posterior face than the sides of this artery. 
In this respect there are different degrees between the entire lateral 
insertion of these arteries and the origin of those which correspond on 
the right and on the left by a common median trunk often several lines 
in length, before dividing into the right and left lumbar arteries.(l) All 
the lumbar arteries of the same subject are arranged in this respect after 
the same type. 

These arteries correspond to the intercostal arteries and are also 
formed on the same level as they, both generally and particularly. But 
they are usually larger. Soon after arising, they go outward in the 
groove of the vertebrae, between the fasciculi of the psoas magnus mus- 
cle, to which they give numerous branches, as also to the quadratus 
lumborum and lumbar vertebrae, gradually arrive at the transverse 
processes of the latter, and always divide at their base, opposite the in- 
tervertebral foramina, into a posterior or dorsal and an anterior or lum- 
bar branch. 

(1) Scemmerring (p. 277), who follows Murray (p. 75) in this, does not mention that 
the right and left lumbar arteries arise by a common trunk, but speaks only of the 
fourth. Others, as Mayer, Boyer, Sabatier, Hildebrandt, and Monro, do not speak of 
it at all. Portal is more correct when he states in a general manner that the syno- 
nymous lumbar arteries of the two sides sometimes arise by a common trunk. We 
have found that this anomaly is not unfrequent, and that, as we have already re- 
marked, it usually affects all the lumbar arteries. Its frequency, compared with the 
proportional rarity of a similar arrangement in the intercostal arteries, is worthy 
of remark, as it coincides with the less marked development of the abdominal parietes. 

Vol. II. 39 



306 DESCRIPTIVE ANATOMY. 

The posterior or dorsal branch (R. dorsalis) is usually the smaller, 
and gives off a branch called the spinal lumbar artery {A. spinalis lum- 
balis), which passes into the spinal canal through the intervertebral 
foramen, is distributed on the dura-mater and the pia-mater, descends 
to the cauda equina, anastomoses with the synonymous branch of the 
opposite side and also with the anterior spinal artery, and is distributed 
also to the lower part of the muscles of the back. 

The anterior or lumbar branch (R. lumbaris) goes forward between 
the broad abdominal muscles, within which it anastomoses with the 
branches of the epigastric artery. 

There are usually as many lumbar arteries as there are lumbar 
vertebrae, viz. five. In general however there are not five which arise 
by separate trunks, but many of them, especially the two or three lower 
ones, often arise by a common trunk, which soon bifurcates. Some- 
times this union of the two lumbar arteries on the same side, situated 
one above the other, coincides with that of the synonymous branches 
on the right and left, on one or on both sides, which we have already 
mentioned. 

Most generally even only the four superior lumbar arteries arise from 
the aorta, and the fifth is given off by the anterior branch of the fourth. 

Thus we usually observe at most but four aortic lumbar arteries.(l) 

Finally, there is no symmetry in this respect between the lumbar 
arteries of the two sides of the body. 

§ 1468. The first lumbar artery is frequently deficient, and in most 
subjects it arises from a trunk in common with the last intercostal 
artery or it is replaced by the branches of the latter. It is always 
small, so that when this arrangement exists and while at the same 
time the inferior lumbar artery arises by a secondary branch, which is 
much more common, we observe only three of these arteries. 

Even when it is separated from the last intercostal artery, it proceeds 
a short distance below the lower edge of the last rib, under the insertion 
of the diaphragm. Sometimes its anterior branch curves between the 
transversalis abdominis muscle and the peritoneum along which it 
descends. 

The second lumbar artery usually arises between the second and the 
third lumbar vertebras ; it goes first a little from below upward, then 
from before backward, and from within outward in the groove of the 
second vertebra. Its anterior branch is distributed principally in the 
quadratus lumborumand transversalis abdominis muscle. 

The third lumbar artery arises between the third and fourth lumbar 
vertebras, and descends on the first of these two bones. Its anterior 
branch is very large and passes between the psoas magnus and the 

(1) This assertion cannot be disputed, when we speak of the trunks which arise 
directly from the aorta. Boyer (p. 127) and Portal (p. 290) have adopted it. But it 
is very incorrect to consider, with Ilaller and Sabatier, the inferior intercostal as the 
first lumbar artery, and consequently to admit six lumbar arteries, although the first 
lumbar not unfrequently arises from the last intercostal artery, or is replaced by its 
branches. 



ANGEIOLOGY. 307 

quadratus lumborum muscles, to which it gives branches, descends 
toward the anterior part of the crest of the ilium, and directly above 
this place goes through the abdominal muscles to the gluttei, where it 
ramifies and anastomoses with the gluteal artery. 

The fourth lumbar artery arises on the fourth lumbar vertebra, or 
between the fourth and the fifth. Its anterior branch passes before the 
quadratus lumborum muscle, proceeds forward on the crest of the 
iUum, through the muscles of the back, to enter, like the preceding, 
into the gluteei muscles. 

The fifth lumbar artery is a branch of the sacral artery ; we shall 
therefore describe it when speaking of the latter. 



CHAPTER V. 

ARTERIES OF THE PELVIS AND THE LOWER EXTREMITIES. 

§ 1469. The aorta usually divides on the fourth lumbar vertebra, or 
between the fourth and fifth, into two or three trunks. Two are much 
larger and more constant, and are the arteries of the lower extremities 
(A. crurales, Barclay) being called at their origin the primitive iliac arte- 
ries ; they separate from each other at an acute angle and go outward. 
The third trunk is much smaller and inconstant, and is called the 
middle sacral artery. 

I. MIDDLE SACRAL ARTERY. 

§ 1470. The middle sacral artery (A. sacra, s. sacralis media), 
although very small, being no larger than a lumbar artery, is very 
remarkable, first, because from its situation and distribution it in fact 
represents the continuation and the end of the trunk of the aorta ; 
secondly, because it adds to the analogy already existing between the 
distribution of the upper end and that of the lower part of the aorta. 

When it arises from the aorta, it comes from its posterior side, directly 
above the origin of the two primitive iliac arteries. It is not unfre- 
quently given off by the latter, especially that of the left side, from 
which it generally then arises very high, directly below its origin. 

It descends more or less exactly on the centre of the anterior face 
of the body of the last lumbar vertebra, and of those of all the false 
vertebrae of the sacrum and coccyx, directly upon the surface of these 
bones, and curves frequently. 

[t gives off only lateral branches. 

The first and largest is usually the fifth or the last left lumbar 
artery (§ 1469), which is sometimes larger than the continuation of 
the trunk, and then the middle sacral artery seems to arise from the 
inferior lumbar artery. 



308 DESCRIPTIVE ANATOMY. 

This branch, like all the lumbar arteries, goes backward and out- 
ward. It divides, before the intervertebral foramen, between the fifth 
lumbar vertebra and the first false vertebra of the sacrum, into two 
branches, a posterior or dorsal, and an anterior, which is much larger. 
The first is distributed as usual ; it goes outward, under the psoas 
magnus muscle, and sometimes, when the fourth lumbar artery does 
not descend so low as usual, it proceeds on the crest of the ilium, and 
goes to the quadratus lumborum muscle, through which it passes into 
the broad abdominal, and also into the glutsei muscles ; sometimes 
when these branches arise from the fourth lumbar artery, and the ilio 
lumbar artery is not as much developed, it penetrates into the psoas 
magnus and the iliacus muscles. 

Two transverse branches more or less tortuous than usually arise 
from the lateral parts of the middle sacral artery on each false vertebra 
of the sacrum ; these go outward, give numerous ramifications to the 
periosteum and to the substance of the sacrum, anastomose with the 
branches of the lateral sacral arteries which go to meet them, pene- 
trate with them into the spinal canal, through the anterior sacral fora- 
mina, then emerge from the posterior sacral foramina, and are expanded 
in the inferior part of the multifidus spinae muscle. 

The middle sacral artery finally terminates at the end of the coccyx, 
in the lower extremity of the rectum and in the fat which surrounds 
this intestine. 

This artery is not always single ; it sometimes divides into two 
branches, which anastomose with each other and with the lateral 
sacral arteries. 

There is constantly an inverse relation between the middle and the 
lateral sacral arteries in respect to their development, when one or the 
other is unusually large. 

II. PRIMITIVE ILIAC ARTERIES. 

§ 1471. The primitive iliac arteries (Jl. iliacoz primitives, s. commu- 
nes, s. pelvi-crurales, s. crurales lumbales, s. cruri-lumbares) separate 
at an acute 'angle, go outward, downward, and forward, on the 
last two lumbar vertebrae, and on the first false vertebra of the 
sacrum, the right after passing on the left primitive iliac vein, the left 
proceeding directly before and at the same time on the outside of the 
synonymous vein, and divide as high as the sacro-iliac symphyses, 
into two considerable trunks, the hypogastric and the external iliac 
artery. 

The primitive iliac arteries usually have about the same length 
and caliber on both sides. The right however is most generally a 
little higher than the left, because the aorta occupies the left side of 
the vertebral column as the primitive iliac arteries, nevertheless, both 
arise at the same height. The left descends a little more vertically 
than the right. Those authors who mention some difference between 



ANGEIOLOGY, 309 

the two primitive iliac arteries, especially Mayer, and after him Scem- 
merring, indicate only this relation, which in fact is most frequently 
observed. These anatomists also assert that the right primitive iliac 
artery is a little smaller than the left. 

We have never observed this last difference, but rather the contrary. 
The first in fact generally occurs, although we have sometimes but 
very rarely remarked an inverse arrangement, and even in a much 
more evident manner, although the aorta ascend as usual on the left 
of the vertebral column. 

In one case of this kind now before us the right primitive iliac artery 
is nearly a third shorter than the left, and bifurcates between the fourth 
and fifth lumbar vertebra?. 

The most usual arrangement is remarkable, because it adds still more 
to the analogy between the upper and lower halves of the body, since 
the greater length of the right primitive iliac artery resembles the inno- 
minata of the right side, and that of the left side the origins of the left 
carotid and subclavian arteries by two distinct trunks. The latter 
arrangement however is only indicated at the lower extremity of the 
aorta, where a perfect repetition has not yet been found, at least to our 
knowledge. 

The rarest arrangement corresponds to the inversion of the right 
and left trunks of the arch of the aorta, which has been sometimes 
observed, although the aorta presented no other anomalies. 

The primitive iliac arteries usually give off in their course small 
branches, which go to the psoas and the iliacus muscles, the ureters, 
the vena-cava, and the lymphatic glands of this region. They rarely 
give off a part or the whole of the ileo-lumbar artery, and still more 
rarely they supply a renal or a spermatic artery. 



ARTICLE FIRST. 

I. HYPOGASTRIC ARTERY. 

§ 1472. The hypogastric artery (Jl. hypogastrica s. iliaca interna, s. 
■posterior pelvica, s. htjpoiliaca) descends a little forward and inward, 
soon penetrates, almost vertically, into the cavity of the pelvis, where 
it always divides, near its origin, into several branches, which vary in 
size, and are not always arranged exactly in the same manner, and do 
not arise from it constantly. It thus distributes the blood to all the 
parts within the pelvis, to its parietes, and to the muscles which sur- 
round it. It is always more or less evidently divided into two branches, 
a posterior and an anterior. 

§ 1473. The posterior branch gives constantly the gluteal, the 
ileo-lumbar, the lateral sacral, and the obturator arteries. From the 
anterior arise the ischiatic, the umbilical, and the internal pudic arte- 



310 DESCRIPTIVE ANATOMY. 

ries, which usually give off the middle hemorrhoidal, (he uterine, the 
vaginal, and the vesical arteries. Frequently however the secondary 
branches, particularly those of the posterior branch, arise from the 
trunk of the hypogastric artery, or from the anterior branch ; the first 
is true, particularly of the ileo-lumbar, and the second of the obturator 
artery ; the two latter not unfrequently do not arise from the hypogas- 
tric artery but very far from the usual place, either from the primitive 
iliac or from the crural artery. 

I. ILIOLUMBAR ARTERY. 

§ 1474. The ileo-lumbar artery (A. ileo-lumbalis) is usually the first, 
which arises from the posterior branch of the hypogastric artery, and 
is frequently divided into several, sometimes into three or four, trunks, 
which come from different points. Not unfrequently it partially or 
wholly arises from the primitive iliac, from the trunk of the hypogas- 
tric artery, from the anterior branch of the latter, or from the crural 
artery, or, as happens particularly on the left side, from the middle 
sacral artery, or, finally, it forms a common trunk with the lastl um- 
bar artery. Its volume is by no means always the sarnie. 

It goes almost horizontally outward and backward, and soon divides, 
usually near the sacro-iliac symphysis, into an ascending and a 
descending branch. 

The ascending branch ascends between the psoas and iliacus mus- 
cles, to which it sends ramifications, anastomoses with the inferior 
lumbar artery, which it sometimes entirely replaces, or which in other 
cases takes its place, and either alone or with the latter, sends branches 
into the spinal canal through the last intervertebral foramen of the 
lumbar region. 

The inferior branch is more or less transverse, although a little 
oblique from above downward ; it goes outward, and divides into 
superficial and deep branches. 

The former are distributed on the anterior face of the psoas and iliacus 
muscles. The others between the latter and the os ilium, enter the 
muscle through its attached face, and thus penetrate into the substance 
of the tone through several foramina of nutrition. 

All these branches proceed outward and forward, and frequently 
communicate with those of the circumflex iliac artery. 

The anterior branches are distinct, and usually arise from the ante- 
rior branch of the hypogastric artery ; they are small, and go to the 
iliacus and psoas muscles. When the ilio-lumbar artery divides into 
two large branches it often gives off only an ascending and a descend- 
ing branch ; but the superficial portion of the descending branch is 
frequently £. part of the superior, and the anterior is formed only by the 
deep branches. 



ANGEIOLOGY. 311 



II. LATERAL SACRAL ARTERY. 



§ 1475. The lateral sacral artery {Jl. sacra lateralis)^ is perhaps 
more frequently double than single, and is sometimes given off by the 
trunk of the hypogastric or by the ileo-lumbar artery ; in some sub- 
jects it is the first artery of the posterior branch of the hypogastric 
when the preceding artery arises from another point. It is rarely 
given off by the primitive iliac artery. It goes backward and inward 
and descends on the anterior face of the sacrum, before the anterior 
sacral foramina. 

In this course it divides into internal and posterior branches. 

The internal are distributed on the anterior face of the false vertebrae 
of the sacrum, to which they give their branches, and anastomose with 
the lateral branches of the middle sacral artery (§ 1470). 

The posterior or external penetrate in the anterior sacral foramina 
and soon divide into branches, an anterior, distributed on the posterior 
face of the body, and a posterior, which emerges from the posterior 
sacral foramen, and is distributed in the lower part of the muscles of 
the back. 

All these branches give twigs to the lumbar and sacral nerves, also 
to the membranes of the spinal marrow, and anastomose with the ante- 
rior spinal artery. 

When the lateral sacral artery is double, the upper portion, which 
goes only backward, is usually separated from the lower ; but in this 
case it does not always come from the trunk of the hypogastric or from 
the ileo-lumbar artery ; it as often arises above the inferior portion, be- 
fore the posterior branch of the hypogastric artery. 



III. OBTURATOR ARTERY. 



§ 1476. The obturator artery (A. obturatoria) is very inconstant in 
its origin. It usually arises from the posterior branch of the hypogas- 
tric artery, whence it comes directly or by a trunk in common with the 
ileo-lumbar artery, but frequently, at least once in ten times, is given off 
at another part. 

The general character of all these differences in its origin is, that it 
arises farther outward and forward. 

The anomaly is least when the obturator artery arises from the hy- 
pogastric artery above and before the place where the latter divides 
into an anterior and a posterior branch. 

Next come the cases where it arises from the anterior branch of the 
hypogastric 

The anomaly is still greater when it arises from the primitive iliac 
artery. The latter gives it off either within or without the cavity of 
the pelvis, sometimes directly and sometimes indirectly. 



312 DESCRIPTIVE ANATOMY. 

It arises from different parts of the inner and outer portion of the 
primitive iliac artery. 

Sometimes it is given off by the superficial femoral artery, two inches 
below Poupart's ligament. 

When it is not a direct branch of the crural artery, it arises by a trunk 
in common with the epigastric artery. The most usual case, which is 
almost as common as that where the artery arises from the hypogastric 
artery, is, according to our observations, as 16 : 1, in respect to its fre- 
quency with that where it arises directly from the crural artery. 

The common trunk varies in length from two lines to two inches, 
but it is usually short and its origin is no higher or lower than usual ; 
in both cases however its length exceeds the rule. 

But in all these anomalies, however remotely the obturator artery 
may arise from its usual place, it always passes on the horizontal branch 
of the pubis to enter into the cavity of the pelvis and be distributed as 
usual, and emerges from this cavity through the obturator foramen. 
This peculiarity is an important argument in support of the law, that 
when the organization presents an anomaly it always approximates as 
much as possible to the normal state. 

Between the cases where the obturator artery arises from the hypo- 
gastric artery and where it comes from the crural artery, we find an 
intermediate case, where it arises from the union of two branches 
nearly equal in size, an anterior and a posterior, which arise, the former 
from the epigastric or the crural artery, the other from the hypogastric 
artery, and which anastomose at an acute angle. 

It is pleasant to observe that these differences are indicated in the 
most normal formation, since a smaller or larger anastomosing branch 
always passes above the horizontal branch of the pubis, extends from 
the obturator artery given off by the hypogastric artery to the crural or 
to the epigastric artery. Consequently the internal obturator artery 
always arises to a certain extent from an anterior and a posterior branch. 
When the posterior is more developed, the artery seems at first view to 
come principally from the hypogastric artery, while, when the anterior 
branch is larger than the other, we are led to conclude that the obtu- 
rator artery arises from the femoral or from the epigastric artery.(l) 

(1) These anomalies in the origin of the obturator artery are common, aa we have 
already remarked. Portal, although he asserts that the origin of this vessel is very 
inconstant, brings forward as proof only the cases where it arises from the trunk or 
from the branches of the hypogastric artery, but when describing this or the epigas- 
tric artery, he mentions those only where it arises from the latter or from the crural 
artery. Mayer only remarks that the obturator artery is sometimes given offby the 
crural or by the epigastric artery. Hildebrandt does not mention, when speaking 
of the obturator or of the epigastric artery, the anomaly which occurs when the first 
arises from the second, although this is more common than when it arises from the 
crural artery. He only says that it comes from the hypogastric or from the crural 
artery, and thus he at least indicates the frequency of the latter arrangement. Monro 
says that it is sometimes given offby the epigastric artery (p. 353). Sabatier (p. 108) 
and Boyer (p. 134) remark that it arises in some subjects from the epigastric or from 
the crural artery. Murray mentions only those cases where it arises from the epi- 
gastric artery. Haller, Scemmerring, Bichat, Hardrops, Burns, Cooper, and Monro 



ANGF.IOI.OGY. 313 

This arrangement of the obturator artery is not necessarily the same 
on the light and left side, any more than are the varieties of any other 
artery. It follows however, from our observations, that it is more com- 
mon or at least as common to find both sides of the body formed after 
the same type as to find this type only on one side. Thus in most of 
the preparations before us, the obturator artery comes on both sides from 
the hypogastric ; in four, it arises by a trunk in common with the epi- 
gastric artery, and there are five only in which it arises from the epi- 
gastric artery on one side, and on the other, directly from the crural ar- 
tery by a trunk in common with the epigastric artery. 

When the obturator artery arises from the epigastric only on one 
side, this variety generally occurs on the left. At least our observations 
have shown that the cases in which it arises from the left epigastric 
artery are to those where it comes from the right as 10 : 1. We do 
not think that sex has any influence in this respect ; we have not ob- 
served that the origin of the obturator artery outward is more com- 
mon in the female than in the male, as Hesselbach asserts. 

§ 1477. Most commonly, when the obturator is a branch of the hy- 
pogastric artery, it goes outward and forward, directly below the upper 
edge of the cavity of the pelvis, gives off in its progress some inconstant 
ramuscules to the levator ani and obturator internus muscles, to the 
glands of the pelvis, and to the obturator nerve which accompanies it, 
passes through the upper and tendinous part of the obturator internus 
muscle, at the upper part of the obturator foramen, and emerges from the 

have written the best upon this artery. Haller says (Ic.fasc. x. expl. tab. i. not. 9) : 
JVon tamen perpetuum est, earn arteriam a pelvis truncis nasci, cumnovies viderim 
ex epigastrica ortam. Scemmerring expresses himself with much exactness. This 
artery, he says, is not constant in its origin ; it sometimes arises from the crural and 
often from the epigastric artery (p-. 294). Bichat also mentions the frequency of this 
last origin. Wardrop says he has observed it in many subjects. The details on the 
origin and distribution of this artery given by Burns are most correct ; they perfectly 
agree with our own observations. He says the obturator artery is usually regarded 
as a branch of the internal iliac artery, but we have as good right to assert that it 
arises from the trunk or from one of the branches of the external iliac. We have often 
seen it come from this vessel, an inch above Poupart's ligament. It frequently arises 
by a trunk in common with the epigastric artery. These details are given in hiB 
treatise on diseases of the heart. Farther ( Observations on the structure of the parts 
contained in crural hernia ; in the Edinb. Med. and Surg. Journ., vol. n. p. 272), 
he says that the obturator and the epigastric arteries often arise by a common trunk ; 
perhaps however this arrangement may be considered as a rare anomaly, but he has 
observed it more than twenty times. Cooper ( The anatomy and surgical treatment 
of crural and umbilical hernia, 1807, Edinb. Med. and Surg. Journ., vol. iv. p. 231) 
also states, when speaking of the origin of the obturator and epigastric arteries by a 
common trunk, that it is not rare. Monro (Anat. of the gullet, p. 429) establishes the 
relation between this case and those where it does not exist as 1 : 10. Bekkers also 
mentions (Diss, de licrnia inguinali, Paris, 1813) three cases observed by nimsell, in 
which these two vessels arose in common from the external iliac artery. We have 
mentioned these cases, which support our observations, because Hesselbach (J\eucsle 
anatomisch-palhologisch Vntersuchangcnuberden Vrsprung und das F ortschreiten 
der Leisten-und Schenckelbruche, Wurzburg, 1815) is wrong on this subject, tic 
maintains, which seems impossible in so distinguished an anatomist, not only ■tnat 
this variety is very rare but adds, that, as to his knowledge the lesion of this artery 
has been observed only in females, the injury of the obturator artery in the male is 
not to be feared. 

Vol. II. 40 



314 nr.srniPTiVF. anatomv. 

pelvis to be distributed to the upper and internal part of the thigh. It 
usually gives off also, before leaving the pelvis, a branch, which anas 
tomoses with a corresponding branch of the opposite side on the sym- 
physis pubis, and always gives origin to a branch, which varies in 
size and anastomoses with the epigastric artery above the. horizontal 
branch of the pubis 

In or directly before the obturator foramen, the obturator artery 
usually divides into two branches, an external and an internal. 

The internal branch is smaller and passes above the obturator exter- 
nus muscle, gives branches to it and also to the adductor brevis and 
longus, to the gracilis, to the pectineus, and to the skin of the internal 
part of the thigh, the scrotum or the labia pudenda, commonly anasto- 
moses with the internal circumflex artery of the thigh, and with the 
external branch on the circumference of the obturator foramen, and with 
the external pudic artery in the scrotum and the labia pudenda. 

The external branch descends deeply outward between the obturator 
internus and externus muscles, gives branches to these muscles in which 
it sometimes terminates, is reflected from within outward on the articu- 
lar capsule and the inner part of the articulation to emerge from the ob- 
turator foramen, and passing behind the quadratus femoris muscle goes 
transversely to the posterior part of the extremity ; then it is distributed 
to the quadratus femoris, to the gastrocnemii, to the adductor longus 
and brevis, to the upper extremity of the flexors of the leg, finally, to 
the substance of the external condyle of the femur ; anastomoses with 
the internal branch on the circumference of the obturator foramen and 
with the ischiatic artery above, and within with the internal circumflex 
and the internal hemorrhoidal arteries. 

§ 1478. The varieties in the origin of the obturator artery are very 
important to the surgeon. When this artery arises at the usual place 
from the hypogastric or from the crural artery within the pelvis, 
and even from the epigastric artery, but far above the crural arch, it is 
not exposed to be wounded in any of the common operations. But 
when its origin is situated very low, and it comes either from the crural 
artery or by a trunk in common with the epigastric artery, as it then al- 
ways re-enters the pelvis over the branch of the pubis, it is exposed to 
wounds in the operation for crural hernia. 

When the common trunk of this and the epigastric artery is short, it 
is generally thrown outward toward the ischium in crural hernia, so 
that it would be divided if the incision should be made in this direc- 
tional) 

When, on the contrary, this same trunk is long and the obtuiator 
artery consequently goes farther inward, it is pushed down by the 
crural hernia and proceeds before the neck of the tumor inward. (2) 

(1) See a case of this kind figured in Monro, Morbid anatomy of the human gullet 
Edinburgh, 1811, tab. xiv. fig. 1. ° ' 

(2) Wardrop has figured a case of thus kind (Edinb. Med. and Surg Journ vol ii 
p. 203), and points out the means of avoiding the obturator artery in this case. Sec 



ANGEIOLOGV. 315 

We must however in this case determine whether the crural hernia 
is situated more or less outwardly. 

If an external and an internal crural hernia exist on one side, the 
obturator artery sometimes passes to the inside of the external tumor, 
even when the common trunk of this vessel and of the epigastric artery 
is short, and enters the cavity of the pelvis between the two tumors. 
This has been observed by Burns. 

If the obturator artery rises far below the usual place and from the 
crural artery, either directly or by a trunk in common with the epi- 
gastric artery, it generally proceeds deeply, along the pectineus muscle, 
on the inside of the crural vein, so that, being situated behind the 
tumor, in case of crural hernia it cannot be wounded in the operation. 

But if it was nearer the surface, it might be situated also on the 
anterior face of the tumor. We have never seen this latter arrange- 
ment. Burns and Monro have observed only the first. 

IV. Gt.UTEAL ARTERY. 

§ 1479. The gluteal or posterior iliac artery (Jl. glutea, s. iliaca 
posterior, s. externa), the largest artery of the posterior branch of the 
hypogastric artery, which may be considered as its continuation, arises 
very often by a trunk in common with the ischiatic artery. Some- 
times it furnishes the lateral sacral, the obturator, and all the other 
arteries which usually come from the posterior branch of the hypo- 
gastric artery. It goes downward, forward, and outward, toward the 
lower part of the ossa ilia, usually sends off, in this course, branches 
to the iliacus intumus muscle, to the obturator internus, to the pyri- 
formis, to the levator ani, and to the os pubis, then emerges from the pel- 
vis through the ischiatic notch, between the pyriformis and the gluteus 
minimus muscle, is reflected from below upward, penetrates between 
the gluteus medius and minimus muscles, and divides into numerous 
branches, which are distributed to the pyriformis and to the three 
glutei muscles and anastomose above with the epigastric, the last 
lumbar, and ilio-lumbar arteries, below with the ischiatic and with the 
external circumflex artery. 

§ 1480. The anterior branch of the hypogastric artery gives off", 
first, the ischiatic artery, the internal pudic, and the umbilical arteries. 
The vesical, uterine, and vaginal arteries come from one of the latter ; 
sometimes also they arise by a common trunk. 

V. ISCHIATIC ARTERY. 

§ 1481. The ischiatic artery (A. ischiadic a) arises separate from the 
internal pudic artery less frequently than by a trunk, which varies in 
length, in common with the latter, and often by a trunk in corn- 
Bums, Observations on the structure of the parts contained in crural hernia, in the 
Edinburgh Med. and Surg. Journ., vol. ii. p. 273, fig-. 1. 



316 DESCRIPTIVE ANATOMY. 

mon with the gluteal artery. It descends before the latter, but at the 
ischiatic notch it turns backward, continuing still to descend, and 
emerges from the pelvis, below the pyriformis muscle. 

The common trunk of the ischiatic and of the internal pudic arteries 
frequently does not bifurcate, except in this place, to give origin to two 
arteries ; and from its portion within the pelvic cavity arise branches 
which are distributed to the pyriformis, to the obturator internus, and 
to the levator ani muscles. 

On emerging from the pelvis the ischiatic artery sends, to the pos- 
terior part of the ilio-femoral articulation, branches which anastomose 
with the circumflex arteries. It afterward goes backward, toward the 
gluteus maximus muscle, into which it penetrates from within out- 
ward, and within which it is almost entirely distributed. 

It often gives off the middle hemorrhoidal, the uterine, the vaginal, 
and the vesical arteries, especially when it arises by a long trunk, in 
common with the internal pudic artery. 

It not unfrequently gives off an inferior lateral sacral artery when 
the usual artery of this name does not descend very low, and is unu- 
sually small. 

It constantly anastomoses by large branches, above, with the ischi- 
atic artery, and with the circumflex arteries below, around the coxo-femo- 
ral articulation of the large trochanter. 

VI. INTERNAL PUDIC ARTEEY. 

§ 1482. The internal pudic artery (Jl. pudenda interna, s. communis, 
s. circumflexa, s. pudica pelviena, s. hcemorrhoidea externa) descends 
into the pelvis, directly before the ischiatic artery, which is generally 
larger than it, and when it is not given off in this place or even after- 
ward by the latter, emerges with it from the cavity of the pelvis, 
between the pyriformis muscle and the large sacro-sciatic ligament, 
between the latter and the small sacro-sciatic ligament, afterward 
re-enters the pelvis, where it continues to the symphysis pubis, descends 
along the posterior edge of the descending branch of the ischium, on 
its internal face, to the tuberosity of the ischium, then reascends, always 
on the inner side of the bone, along its ascending branch and the 
descending branch of the pubis, between the obturator internus and 
the levator ani muscles, and having come above the symphysis pubis, 
terminates in the external organs of generation. 

Thus the pudic artery usually emerges from the pelvis through the 
sciatic notch, and re-enters it between the two sacro-sciatic ligaments 
to leave it a second time below the symphysis pubis ; but not unfre- 
quently, especially in the male, it always continues in the cavity of the 
pelvis, and then, proceeding on the lower and lateral portion of the 
bladder, it goes forward, across the upper part of the prostate gland, 
where Burns remarks it may be wounded in the operation of lithotomy 
particularly when the summit of the prostate gland is cut. 



ANGEIOLOGY. 317 

It often gives off within the pelvis one or several vesical arteries, the 
middle hemorrhoidal, the vaginal, or the uterine, and even the obtu- 
rator arteries. It also sends smaller branches to the internal parts of 
the genital and urinary apparatus. In its course along the descend- 
ing branch of the ischium, besides several small branches which go to 
the bone, to the obturator internus muscle, to the upper extremity of 
the flexor muscles of the thigh, to the lower part of the rectum, and 
to the sphincter ani, it gives off others also, of which the principal are, 

1st. A considerable branch which goes outward, between the large 
trochanter and the ischium, divides into several branches, descends on 
the neck of the femur and the capsule of the ilio-femoral articulation, 
between the obturator internus and extemus muscles, gives ramuscules 
to these muscles, and also to the quadratus femoris and to the gemelli 
muscles, and anastomoses with the circumflex arteries. 

2d. One or more rather large internal branches, which go to the 
inferior part of the rectum, also to the anus, and form the external or 
inferior hemorrhoidal artery (Jl. hcemorrhoidea externa, s. inferior). 

A little above the tuberosity of the ischium, the internal pudic artery 
divides into two branches, an internal transverse, and an external 
anterior ascending branch. 

The internal branch, the perineal artery (R. internus, s. transversus, 
s. superjicialis, arteria perinaa, s. transversa pcrincei) is smaller than 
the external. It goes inward and a little forward along the transver- 
salis perinei muscle, usually between it and the skin, distributes 
branches to these parts, and also to the other muscles of the penis, and 
to the constrictor vaginae in the female ; gives some branches to the 
lower part of the rectum, and to the sphincter ani, which are termed 
the external or inferior hemorrhoidal arteries (Jl. hcemorrhoidales infe- 
riores, s. externa^,) and sends others also to the skin of the perineum, 
labia pudenda, and scrotum. 

The external, anterior, superior, or deep branch (R. anterior, s. supe- 
rior, s. profundus, s. pudendus) is called the artery of the penis (Jl. 
penis) in the male, and the artery of the clitoris (Jl. clitoridea) in the 
female. When the internal pudic artery gives off considerable 
branches within the pelvis, this artery not unfrequently arises mostly 
from the other adjacent branches of the hypogastric artery, especially 
from the obturator artery, less frequently from the external iliac artery, 
particularly from an external pudic artery, an anomaly which is indi- 
cated in the normal state by the more or less manifest anastomoses 
between the internal and the external pudic arteries. 

This artery is much larger in the male than in the female on account 
of the greater proportional size of the parts to which it is distributed. 

In both sexes it proceeds from below upward, around the inner face 
of the pubis and ischium, between the bone and the corpus cavernosum 
of the penis and clitoris, and distributes branches to the vagina and 
prostate gland, the labia pudenda, and the scrotum, finally to the cli- 
toris and the penis, which branches are arranged after the same type. 



318 DESCRIPTIVE ANATOMY. 

The branches which go to the prostate gland and the scrotum id 
the male, to the vagina and to the labia pudenda in the female, are 
given off the first, directly above the sciatic tuberosity. 

After these the trunk descends along the ischium and the pubis, 
covered by the erector penis (levator penis, clitoris), and thus comes 
into the triangular space below the symphysis pubis, where the roots 
of the corpus cavernosum of the penis in the male, and of the clitoris 
in the female unite. 

In both sexes, the artery then divides into two branches, the super- 
ficial and the deep branch. 

The superficial or the dorsal branch, the dorsal artery of the penis 
or clitoris (R. dorsalis, s. superficialis penis vel clitoridis), passes through 
the suspensory ligament. It is very tortuous when the penis is not 
erected, and proceeds under the skin at the side of the synonymous 
artery of the opposite side, with which it sometimes unites, after a 
very short course, advances thus on the back of the penis, and gives 
branches to its skin and its fibrous membrane, and sends off others 
which descend into the scrotum. At the groove behind the glans, it 
forms a crown around it, and finally penetrates into its substance. 

The deep branch or the cavernous artery (Jl. profunda, s. cavernosa 
penis, s. clitoridis) passes through the fibrous membrane of the corpus 
cavernosum of its side, thus penetrates into the substance of this body, 
and soon divides into several branches. These proceed from behind 
forward, along the penis, expand in the corpus cavernosum of both the 
penis and urethra, and frequently anastomose with those of the oppo- 
site side. " 

The two deep branches often unite in a single common trunk. 

Sometimes the internal pudic artery terminates much sooner than 
we have mentioned, in the transverse perineal artery, and the dorsal 
artery of the penis or clitoris arises wholly or in great part from the 
obturator artery. 

VII. UMBILICAL ARTEHY. 

§ 1483. The third artery of the anterior branch of the hypogastric 
artery, the umbilical artery (Jl. unibilicalis), is before birth the continu- 
ation not only of the trunk of this artery, or even of the primitive iliac 
artery, but is larger than the hypogastric and femoral arteries, and is 
the continuation of the aorta. 

At all periods of life the umbilical artery goes a little obliquely for- 
ward and inward, toward the upper part of the lateral wall of the 
bladder, to which it is attached by mucous tissue. Thence it proceeds 
along this wall, toward the posterior face of the anterior wall of the 
abdomen, and thus goes from behind forward and from below up- 
ward to the umbilicus. 

In the fetus it is open in its whole extent, but soon after birth it is 
gradually obliterated after leaving the umbilicus, so that finally it 



ANGEIOLOGY. 319 

affords a passage to the blood only in the part between its origin and 
the bladder, the rest of it being changed into a full and solid ligament, 
enveloped by a fold of the peritoneum, and which may be generally 
traced to the umbilicus. 

During fetal existence, the lower and anterior part of the umbilical 
artery which is convex, gives off not only the branches of the hypo- 
gastric artery, which we described above, but also, first, the inferior 
vesical, then the vaginal, next the uterine, and finally one or more 
superior vesical arteries, which generally are very distinct from each 
other. But as it is gradually obliterated, and as at the same time the 
lower extremities and their vessels are developed, these arteries 
approach each other, and seem to be in part the upper arteries of the 
anterior branch of the hypogastric artery. 

These branches arise in the following order, which we adopt, since 
in following it the arteries to be described, correspond from behind for- 
ward to those already mentioned. 

VIII. VESICAL ARTERIES. 

§ 1484. The vesical arteries (Jl. vesicales) are distinguished into 
inferior and superior. 

The inferior are larger than the superior, and generally there is 
only one. They arise from the umbilical or from an anterior branch 
of the hypogastric artery, which is usually the internal pudic, or from 
the trunk of the hypogastric artery ; they go downward and forward 
to the lower and posterior part, and also to the neck of the bladder, 
the commencement of the urethra, to the prostate gland and to the 
vesiculae seminales in the male, and to the lower part of the vagina in 
the female. 

The superior are generally smaller and more numerous ; they 
always arise from the lower part of the umbilical artery, consequently 
from the most anterior part or from the extremity of the hypogastric 
artery, and go to the middle and superior part of the bladder. 

JX. MIDDLE HEMORRHOIDAL ARTERY. 

§ 1485. The middle hemorrhoidal artery (Jl. hozmorrhoidea media) 
often follows the inferior vesical artery from below upward, and from 
behind forward ; but frequently also it arises lower than it, being even 
sometimes deficient, and is given off by the ischiatic or by the internal 
pudic artery. Sometimes it arises from the upper or lower hemor- 
rhoidal arteries, with which it always anastomoses, and is distributed 
on the anterior face of the rectum and also on the posterior part of the 
bladder, where it communicates with the proper vesical arteries. 



320 DESCRIPTIVE ANATOMY*. 



X. VAGINAL ARTERIES. 



§ 1486. One or two vaginal arteries (A. vaginalis) usually follow 
the inferior vesical artery. But this artery is frequently deficient, and 
it is then replaced by the ramifications of the vesical, the hemorrhoidal, 
or the uterine arteries. Sometimes also, even when it forms a distinct 
branch, it does not arise in the order mentioned, but comes from some 
one of the arteries of the anterior or of the posterior branch of the 
hypogastric artery. 

It goes forward, inward, and downward. Its branches are distri- 
buted to the inferior and middle regions of the lateral part of the 
bladder and of the vagina. 



XI. UTERINE ARTERY. 



§ 1487. The uterine artery {A. ulerina) generally succeeds the 
vaginal artery, but it frequently varies from this order. It is however 
constant. 

It goes inward, toward the upper part of the vagina, to which it 
gives off some branches, as well as to the bladder ; it then reascends 
in the broad ligament along the lateral wall of the uterus. In its 
course which is very tortuous, it gives off numerous ramifications 
which are also curved, to the anterior and posterior faces of the uterus. 
Some of these ramifications are distributed on the surface and others in 
the substance of this organ. 

Its upper part expands by several branches in the folds of the 
peritoneum ; they go to the internal organs of generation, to the Fallo- 
pian tubes, and to the ovaries, where they frequently anastomose with 
the spermatic arteries. 

§ 1488. In man, the vessels which correspond to the uterine or the 
vaginal arteries are small secondary branches of the vesical and of the 
external hemorrhoidal arteries. 



ARTICLE SECOND. 

EXTERNAL ILIAC ARTERY. 

§ 1489. The external or anterior iliac artery (Jl. iliaca externa, s. 
anterior, s. cruralis iliaca, s.femoralis), from its origin, descends from 
within outward, on the inside of the psoas magnus muscle, sends nu- 
merous small branches to this muscle, and also to the lower part of the 
iliac us muscle. 

It usually gives off, at a greater or less distance from the crural 
arch, two large branches, the epigastiic artery, and the circumflex 



ANGEIOLOGY. 321 

i iiac artery, which are very important in a pathological and surgical 
point of view on account of inguinal and crural hernias. 

The first usually arises a little and sometimes much higher than the 
second, and even above the crural arch ; besides, it always comes from 
the inside of the iliac artery, while the other constantly arises from its 
outside. 

I. EPIGASTRIC ARTERY. 

§ 1490. The epigastric artery {A. epigastrica) is rarely a branch of 
the common or deep crural artery,(l) but it often arises by a trunk, in 
common with the obturator artery, so that we may consider it as giving 
off this latter(2) (§ 1476), although, for all this, its origin is not neces- 
sarily displaced and carried higher than usual. It is often given off, 
sometimes higher and sometimes lower, from the external iliac artery, 
so that the place where it arises varies to the extent of two inches, 
although the obturator artery is not necessarily one of its branches.(3) 
Thus we may consider erroneous the opinion of Hesselbach, who 
asserts that this artery rarely varies in its origin and in its course,(4) 
and also that of Mayer,(5) who, like Burns, asserts that it always 
arises directly below the crural arch. The latter case exists very 
seldom, for the epigastric artery almost always arises above Poupart's 
ligament. On the contrary, the place where it detaches itself from the 
external iliac artery varies much, although it never comes from any 
other vessel. (6) It however generally arises directly above the crural 
arch, (7) and its origin is normal when situated one inch or even two 
inches above this arch. (8). 

(1) Monro, Morbid anatomy of the hitman gullet, Edinburgh, 1811, p. 426. 

^2) At least we have never found in this case that the epigastric was a branch of 
the obturator artery, although we have olten seen both arise by a common trunk, 
and have now several cases of the anomaly before us. Hesselbach, ( Ueber den Or- 
prung und das Fortschrcitcn dcr Lcisten-und Schenkelbruche, Wurtsburg, p. 17) 
and Uekkers (loc. cit., p. 315), mention in fact one case where the epigastric arose 
from the obturator artery. But it is evidently wrong, as it follows from the descrip- 
tion of this anomaly given by the former, in saying that the obturator artery came 
from the inside of the crural more than an inch above the crural arch ; since it fol- 
lows from it we say that the common trunk arose, as is commonly seen in this case, 
from the external iliac, and not from the internal iliac, or hypogastric artery, as 
would be the case provided the expressions of Hesselbach were correct. This ano- 
maly however may sometimes occur. Monro (loc. cit., p. 427) seems to have observed 
it, for he says that in one preparation before him the epigastric arose from the obtu- 
rator artery, and afterward went upward and inward, toward the rectus abdominus 
muscle. 

(3) Which Hesseloach seems to think necessary. 

(4) Hesselbach, loc. cit., p. 17-52. 

(5) Mayer, Heschreibung der Blutgefasse des menschlichen Korpers, p. 206. . 

(6) Monro is very correct in saying (loc. cit., p. 254) that the epigastric artery varies 
much in its origin. 

(7) As has been correctly stated by Bichat (loc. cit., p. 311) and Murray, (loc. cit., 
p. 89). 

(8) Outlines, p. 354. 

(9) According to Scemmcrring, loc. cit., p. 307. 

Voi, IT 41 



322 DESCRIPTIVE AN ATOM 

When the epigastric artery arises unusually high it descends near 
the crural arch, sometimes very low, even below this arch, and always 
passes behind the commencement of the spermatic cord, above the 
inguinal ring, so that it is situated on the inside of this cord. There it 
suddenly curves and reascends vertically on the posterior face of the 
rectus abdominis muscle, first between this muscle and the peritoneum, 
then between it and the posterior layer of the sheath. 

Soon after it is reflected around the spermatic cord, it gives off, di- 
rectly above the inguinal ring, a constant branch, which divides into two 
branches ; one goes downward and backward and anastomoses with 
the iliac artery, the other is transverse and goes inward, proceeds 
along the horizontal branch of the pubis, behind the inguinal ring, and 
communicates with that of the opposite side. It also sends to the 
spermatic cord or to- the round ligament of the uterus, some ramifica- 
tions which penetrate to the scrotum and the labia pudenda, and anas- 
tomose below with the spermatic arteries, and above with the uterine 
arteries in the female. These ramifications, which go to the spermatic 
cord and to the round ligament of the uterus, sometimes come from 
the trunk of the external iliac, even above the epigastric artery, when 
the latter arises lower than usual. This arrangement coincides with 
the very high origin of the spermatic arteries notwithstanding the 
sloping situation of the testicles and of the ovaries, since it manifestly 
depends on the spermatic cord being situated at first higher and more 
internally. 

The trunk of the epigastric artery divides below into two branches, 
the external, which is generally the larger, and the internal, the 
smaller ; it then ascends on the posterior face and in the substance of 
the rectus abdominis muscle, sends off" several branches outwardly, one 
of which is frequently larger than the others, in the internal part of the 
broad abdominal muscles, gives branches to these, the recti, and to the 
pyramidales muscles, and to the peritoneum, and terminates near the 
centre of the abdomen, by anastomosing with the branches of the ex- 
ternal thoracic, the inferior intercostal, and the internal mammary 
arteries. 

The epigastric artery is situated on the outside of the tumor in in- 
ternal inguinal hernia, and on the inside in external inguinal hernia ; so 
that in the former case it is wounded when the incision is carried out- 
ward and in the latter case when the history is directed inward. It is 
rarely so far distant from the inside that it is raised with the umbilical 
artery or with the remnant of this vessel, and consequently proceeds on 
the inside of the tumor, even in an internal inguinal hernia.(l) In 
crural hernia it is usually found outward, so that we run the risk of 
opening it when we cut in this direction. It is however difficult to 
wound it when it does not arise lower than usual, while this is easy 
when it comes from the crural artery, in which case it sometime* 

I) Bekkers, Uk. cit., p. 316. 



ANGEIOLOGY. 323 

ascends on the outside of the inguinal ring, sometimes passes before 
this opening to go to its inside ; it may also be divided, when, although 
it does not arise lower than usual, it descends first superficially and 
resumes its situation afterward to go toward the umbilicus. 

§ 1491. Sometimes a considerable branch arises from the inside of 
the iliac artery, below this artery, the following, or finally the crural 
arch. This is half as large as the epigastric artery, and ascends out- 
side of the inguinal ring, between the external face of the obliquus ab- 
dominis muscle and the skin, gives branches to this muscle, particularly 
to the integuments, extends to the umbilical region, anastomoses below 
with the epigastric artery, and may be considered as the second epigas- 
tric artery. When this branch exists, it is also found on the outside of 
the tumor in an external inguinal hernia, and it is wounded if the bis-- 
fory is carried in that direction. 

II. CIRTUMFLEX ILIAC ARTERY. 

§ 1491. The circumflex or anterior iliac artery {A. abdominalis, s. 
circumflexa iliaca externa, s. iliaca externa minor, s. epigastrica externa) 
usually arises on the outside of the iliac artery, opposite the epigastric 
artery, which is generally a little larger than it. As however it is more 
constant in its origin than the latter, it is not unfrequently placed more or 
less below it. It frequently comes from above the epigastric artery, 
although the latter arises at its usual place. In some subjects it even 
arises from the crural artery, directly below the crural arch, but always 
at least from its outside. It goes directly outward and upward 
toward the iliac crest, frequently sends branches to the tensor fasciae 
lata? and sartorius muscles, always give them to the iliacus muscle, 
and following the direction of the crest of the ilium, proceeds from be- 
fore backward and from within outward, in the lower and middle part 
of the broad abdominal muscles, between which its principal branches 
penetrate. The latter anastomose with the ileo-lumbar and epigastric 
arteries. Others, which go outward, toward the great trochanter and 
the sartorius muscle which they accompany, communicate with the 
ramifications of the crural artery. 

This artery is not unfrequently divided into two trunks, one of which 
generally arises a little below the epigastric artery. 

The external branch is generally much larger than the other, but 
sometimes becomes a small branch, while the principal branches of the 
artery go obliquely inward and upward. In this case, when one or 
more of these branches are considerably large, the operation of para- 
centesis might give rise to a formidable hemorrhage^ 1) 

(1) Ramsay, Account of some uncommon muscles and vessels, in the Edinb. med, 
and surg. journ., vol. viii. p. 282, tab. 1. fig - . 1. 



324 UF.SCRIPTIVE ANATOMY 

ARTICLE THIRD. 

CRURAL ARTERY. 

§ 1493. The external iliac artery after emerging from the crural 
arch, under the centre of which it passes, is called the crural or femoral 
artery (A. cruralis, s. feinoralis communis s. cruralis inguinalis, s. cruri 
inguinalis). It is situated in this place on the neck of the femur, 
almost directly below the skin, covered only by the fascia lata aponeu- 
rosis, the fat, and the lymphatic glands of this region, over the vein 
which accompanies it, and occupies nearly the centre of the space 
between the symphysis pubis and the anterior and superior spine of the 
ilium, between the adductor muscles of the thigh on one side, the. rec- 
tus anticus and the sartorius muscles on the other. 

Beside the small inconstant ramifications which it distributes to the 
skin, to the muscles, and to the lymphatic glands of this region, it gives 
off, sometimes higher and sometimes lower from its inside, one, two, 
and even three external pudic, scrotal, or vulvar arteries, the upper, 
the lower, and the lowest (Jl. pudendal externa!, superior, inferior et 
injima, s. terlia). 

These arteries, which proceed directly under the skin, go from with- 
out inward in the integuments and the fat of the pubis and of the lower 
part of the abdomen, the inguinal glands, the scrotum, and the labia 
pudenda, where they form the anterior scrotal and labial arteries (.#. 
scrotales et labiates anteriores). To this is referred the second epi- 
gastric artery mentioned above. 

§ 1494. The crural artery has not always the same extent. Its 
length is principally determined by the origin of the deep femoral 
artery, which always arises from its posterior and inner side, so as to 
be covered by it. This branch is generally given off from the trunk 
one or two inches below the crural arch, rarely higher,(l) but some- 
times also it arises directly below the arch or even, which is always 
very rare, above it. On these differences depend also those in the size 
of the superficial and deep crural arteries or of the continuation of the 
trunk. When the crural artery arises very high it is usually much 
larger than common, nearly equal to the superficial in size, and then 
it frequently gives off the upper branches of the latter, particularly the 
external pudic arteries, but more frequently still the circumflex arte- 
ries, which we shall mention directly. Sometimes the latter and the 
deep crural artery arise from a common trunk and at the same place. 

(1) Burns has already corrected the error made by Bell, who asserted that this 
division usually occurred four inches above the crural arch 



AXGEIOLOGY. 32$ 



I. DEEP CRURAL ARTERY. 



§ 1495. The deep crural artery (A. cruralis, s. femoralis profunda) 
gives off frequently, not far from its origin, two branches, called the 
circumflex arteries of the thigh {A. circumflexes femoris) } which are 
distinguished into external and internal. This however is not always 
the case. Sometimes, but very rarely, these two arteries (more fre- 
quently one of them, particularly the internal, and very rarely the 
external) arise from the common crural or even from the superficial 
crural artery, below the origin of the deep femoral artery. 



I. CIRCUMFLEX ARTEHIES. 



§ 1496. The internal circumflex artery (A. circumflexa femoris 
interna) generally arises higher than the external. Its origin is some- 
times two or three inches above that of the latter ; hence it comes more 
frequently than the other from the common crural artery, directly below 
the crural arch and the epigastric artery, higher even than the three 
external pudic arteries, and it is thus sometimes given off by the 
external iliac artery. It generally comes from the inside, but in some 
subjects from the outside of the common crural artery. In this case it 
gives one or more branches, which go outward and upward, into the 
inguinal glands, the iliacus and the sartorius muscles, and anastomose 
with those which arise from the crural artery. The trunk goes inward, 
passing in the second case below the crural artery, and at the same 
time descending a little when not unusually high. It gives branches 
to the lower part of the psoas and iliacus, the pectineus, to the short 
and long adductor muscles, afterward goes deeply inward and back- 
ward, below the pectineus muscle, and immediately around the neck 
of the femur, and divides behind the pectineus into two branches, a 
superior or anterior and an inferior or posterior. 

The superior is smaller and soon subdivides into two branches ; the 
external and smaller is called the artery of the cotyloid cavity (A. ace- 
iahuli) ; it goes to the capsular ligament and to all parts of the articu- 
lation, turns on the head of the femur, anastomoses by a large ramus- 
cule with the obturator artery, and distributes branches to the obturator 
externus muscle. The internal is larger, passes behind the adductor 
longus and brevis, and is expanded in the upper part of the adductor 
magnus muscle. 

The inferior branch is much larger than the preceding, and is the con- 
tinuation of the trunk. It descends backward, behind the adductor mag- 
nus muscle, is distributed principally to the gracilis muscle, the three 
long flexors of the leg, the long head of the biceps femoris, the semi- 
membranosus and the semitendinosus, and finally becoming sometimes 
one. sometimes two branches, called the trochanlerian, which are dis« 
tinguished into an upper and lower (R. trochantericv.s superior et infr 



326 DESCRIPTIVE ANATOMY 

rior), it is reflected from before backward, on the inner part of the 
femur, then outward and upward, to arrive at the great trochanter, 
ascends before the gemelli and quadratus femoris muscles, between 
them and the obturator externus muscle, gives branches to these mus- 
cles, and also to the tendon of the obturator internus and pyriformis, 
and anastomoses with the external circumflex, the gluteal, the ischiatic 
the inferior hemorrhoidal, and the obturator arteries. This inferior 
branch is sometimes smaller, and is distributed only to a portion of the 
adductor magnus and to the gracilis muscles ; all the other ramifica- 
tions, especially the anastomo'ic, arising from the superior. 

Beside the anastomoses between the external and the internal cir- 
cumflex arteries at the posterior part of the thigh, these two arteries 
often unite by a very large transverse branch on the anterior face of 
the bone, which, added to their communication with the crural artery, 
completes the circle of anastomosis. 

By all these anastomoses the internal circumflex artery is the prin- 
cipal channel through which the blood comes to the lower extremity 
when the external iliac artery is tied. It is consequently one of those 
vessels which are considerably dilated after this operational ) 

§ 1497. The external circumflex artery (Jl. circumflexa femoris ex- 
terna) arises still more frequently than the preceding, although no f 
always from the outside of the deep crural artery. It comes some- 
times from the place where this latter is given off from the common 
femoral artery, and sometimes much lower. 

It goes obliquely outward, turning on the anterior face of the femur, 
directly on the upper part of the crureeus muscle, gives small branches 
to the lower extremity of the iliacus muscle, and soon divides into an 
ascending and a descending branch. 

The descending branch which arises sometimes wholly, sometimes 
partially, from the superficial or from the deep femoral artery, gives 
ramuscules to almost all the outer part of the triceps extensor, also to 
a small portion of the rectus femoris muscle, and sends upward, across 
this muscle, a transverse vessel which goes to the large trochanter, 
penetrates into its substance, and forms a net work on its surface by 
anastomosing with the ramifications of the internal circumflex artery 

The ascending branch penetrates from before backward and from 
within outward, principally into the gluteus medius muscle, passes 
above the great trochanter, and anastomoses in this place with the 
internal circumflex, the gluteal, and the ischiatic arteries. 

These anastomoses are also very much dilated when the external 
iliac artery is tied. 

II. PERFORATING ARTERIES. 

§ 1498. The deep femoral artery after giving off the circumflex 
arteries goes backward, inward, and downward, so that it descends 

(I) A. Cooper, Account of the anastomoses of the arteries of the groin ; Med < 
Trans., vol. iv. p. 424. 



ANGEIOLOGY. 327 

on the inside of the femur, between the vastus interims externally, the 
adductor longus and brevis internally, and the superficial femoral 
artery forward. In this course it generally gives off some anterior 
and several posterior branches ; the latter are larger and more constant. 

The anterior generally arise very high from- the outer and inner 
sides of the artery. Sometimes there is only one and sometimes we 
find several on each side. The external goes to the vastus internus 
and penetrate also to the crurales muscle. The internal "go to the 
adductor magnus and adductor brevis muscles, and, passing between 
these two muscles, arrive at the upper and middle part of the gracilis 
internus muscle, of which they are the principal nutritious vessels. 

Properly speaking, the trunk of the deep femoral artery divides to 
give rise to the posterior branches, since it penetrates much farther 
back, to the posterior part of the thigh behind the femur. 

These branches have been termed the perforating arteries {Jl.femo- 
ris perforantes), because they pass through the adductor magnus 
muscle to the parts behind it. 

They vary in number from one to five ; for sometimes the whole 
trunk, or at least that part from which the perforating arteries generally 
arise, goes backward, -after passing through the summit of the adductor 
magnus muscle, and then descends behind this muscle, while in other 
cases it proceeds before it, and gradually gives off branches, which 
pass through it to arrive at the posterior part of the thigh. This dif- 
erence is sometimes observed in the two lower extremities of the same 
subject. • 

The saperior ox first perforating artery commonly divides into two 
branches, an upper which ascends, and a lower which descends. 

The superior branch ascends toward and around the great tro- 
chanter, on which it anastomoses with the ramifications of the external 
circumflex artery, and penetrates into the lower part of the gluteus 
maximus muscle, where it communicates with the gluteal artery. 

The inferior branch turns around the femur forward and outward ; 
it is distributed to the vastus externus and to the rectus, and to the 
long head of the biceps muscles. It also gives off the nutritious artery 
of the femur {Jl. nutritia ossis femoris). 

The second and third perforating arteries sometimes arise opposite 
each other, one from the outside the other from the inside of the femoral 
artery. The external goes to the triceps extensor muscle, the internal 
is distributed to the biceps, the semitendinosus, and the semimembra- 
nosus muscles. 

Sometimes we find also two other perforating arteries, an external 
and an internal, which are distributed in the same manner. 

In some subjects the upper branch, then unusuallyMarge, is the 
only one which passes through the adductor magnus muscle. It 
divides into two branches, an ascending which gives all the internal 
ramifications to the flexor muscles ; the inferior is larger, and gives off 
all the external ramifications except the first. The latter is not visible 



32S DESCRIPTIVE ANATOMY. 

externally, but directly where the adductor magnus muscle is inserted 
it passes through this muscle to empty itself from within outward, in 
the vastus externus and the rectus femoris muscles. 

The sciatic nerve also receives considerable branches from the per- 
forating arteries. 

A large branch, the anterior extremity of the trunk of the deep 
femoral artery, always descends before the adductor magnus muscle, 
between it, the adductor longus and brevis muscles, distribute branches 
to these muscles, and near the centre of the thigh give off the inferior 
nutritious artery of this bone. 

Many of these branches, especially the lower, sometimes arise from 
the superficial, and not from the deep femoral artery. They all anasto- 
mose with each other. Farther the superior, as we have already 
observed, communicate with the external femoral and the gluteal 
arteries. The lower and the middle are connected by large anasto- 
mosing branches with recurrent branches, which arise from the lower 
part of the superficial femoral and the popliteal arteries. 

Thus when the common or superficial artery is obliterated to a greater 
or less extent, the perforating branches of the deep femoral artery, and 
generally all its ramifications, are very much dilated, larger even than 
the trunk, as is proved by the observations of Deschamps,(l) Dupuy- 
tren,(2) and Astley Cooper. (3) 

The deep femoral artery supplies the blood to most of the muscles 
of the thigh, to almost all the skin of this extremity, and to its bone ; 
it also gives origin to the accessory vessels for the circulation of the 
blood in the lower extremity. 

II. SUPERFICIAL FEMORAL ARTERY. 

§ 1499. The superficial femoral artery (A. femoralis superficialis, & 
cruralis femoralis, s. cruri-femoralis, s. femoro-tibialis), after the origin 
of the deep, penetrates a little farther, between the vastus internus on 
one side and the adductor longus and brevis on the other, passes below 
the sartorius, to arrive at the inner side of the thigh, proceeds before 
the adductor muscles to the commencement of the lower fourth of the 
thigh, enters in this place the tendon of the adductor magnus muscle, 
and thus comes on the posterior face of the limb, where it is called the 
popliteal artery. 

In its course it gives off branches, of which the principal are the 
internal and the external ; but it also sends off anterior and particular^ 
posterior branches, especially at its lower part. 

The internal branches are distributed in the adductor, the gracilis 
and the sartoius muscles. 

(1) Observ. anat. faites sur un svjct opere suivant le procede dc Hunter, d'un 
aneurysme de I'artere poplitee ; in the Mem. pres. a V Instil., 1805, voL i. p. 251. 

(2) Journ. de Corvisart, vol. vii. p. 536. 

(3) Dissection of a limb, on which the operation/or popliteal aneurysm had been 
performed, in the Med. chir. trans., vol. ii. p. 250. 



ANGEI0L0GY. 329 

The external are distributed in the latter, to the rectus, and particu- 
larly to the vastus internus ; the deep pass behind the femur, and go 
to the vastus externus. 

The anterior distribute blood to the sartorius muscle and to the skin, 
to which also go some ramifications of the other branches. 

The posterior go to the vastus internus, but particularly to the lower 
part of all the flexors of the leg, and as they turn around the femur 
they also penetrate into the vastus externus and extend to the skin. 
They anastomose by large branches above with the perforating arte- 
ries, below with the superior and inferior articular arteries. 

The superficial femoral artery deserves its name, because, during its 
whole course, it is situated near the skin. It is covered for a short 
distance by the sartorius muscle which crosses it. We may then 
easily find it in operations. The place where it is exposed in Hun- 
ter's operation for aneurism is directly below the lower edge of the 
sartorius muscle at the inner part of the anterior side of the thigh.(l) 
The objection that when we operate in this place the articular arteries 
are lost and the circulation cannot continue is unfounded,(2) since 
when the superficial femoral artery is entirely obliterated, the anasto- 
moses of the branches of the deep femoral artery with the lower 
branches of the superficial, and with those of the popliteal artery, supply 
channels which are large even in the normal state, and through which 
the blood may pass from the branches of the deep femoral into the 
articular arteries, and into all the parts below the ligature. 

III. POPLITEAL ARTERY. 

§ 1500. The popliteal artery («#. poplitcea, s. cruri-poplit<za, s. 
femoro-poplitcea) is the lowest portion of the femoral artery, and 
descends into the calf of the leg, inclining a little from within outward ; 
it extends from the beginning of the lower fourth of the femur to the 
summit of the upper fifth of the leg. Sometimes it is much longer, 
because the superficial femoral artery penetrates the adductor magnus 
higher, and also divides a little higher. 

It is separated at its upper part 'from the femur and from the posterior 
face of the capsular ligament of the femoro-tibial articulation at its 
central part, by an abundance of fat and cehular tissue. The tibialis 
posticus muscle separates it below from the tibia. 

Behind, it is separated at its upper part from the skin by the sciatic 
nerve and the popliteal vein, by fat and by mucous tissue ; in its lower 
part, by the muscles of the calf of the leg, and the plantaris muscle. 

Above, it is separated by abundance of fat and cellular tissue, out- 
ward from the biceps femoris muscle, and inward from the semitendi- 

(1) Home, An account of Hunter's method of performing the operation for the 
cure of popliteal aneurysm, in the Trans, of anass. for the improv. of meet, and 
surg. knowl., vol. i. no. 4. Additional cases, &c. ibid. vol. ii. no. 19. 

(2) Deschamps, loc. cit., vol. i. p. 254. 
Vol II 42 



3.3D DKSCRIPTIVK AlfATOMI 

nosus and the semimembranosus muscles. The two upper heads of 
the triceps extensor muscle closely envelop it at its lower part. It is 
then looser and also nearer the bone above and below, but is every 
where surrounded with an abundance of fat and cellular tissue. This 
circumstance, added to the prominence of the flexor muscles of the 
tibia and of the fibula, renders it difficult to fix it and to compress it. 

§ 1501. Beside certain inconstant branches which, when it passes 
through the tendon of the adductor magnus muscle higher than usual, 
appear near its origin, on the posterior face of the thigh, it gives off, 

1st. From its upper part or crural portion, particularly from the 
posterior and inner side of this portion, several branches, which go to 
the lower part of the flexor muscles of the tibia. 

2d. Lower down three superior articular arteries (Jk. s. rami articu- 
lares superiores), which are distinguished into internal, external, and 
middle, which sometimes, even usually, all, or at least two, arise by a 
common trunk from the anterior side of the popliteal artery. Some of 
these arteries are double in some subjects, then only one is detached 
from the trunk before the other, and the superior anastomoses with the 
muscular branches mentioned before. The internal and external are 
usually larger than the middle. 

§ 1502. The external superior articular artery {A. articularis genu 
superior externa) rests directly on the tibia, and passes between this 
bone and the common tendon of the biceps muscle, usually goes from 
below upward, but alwaj's from behind forward and from within out- 
ward, and gives off, in its course, ramifications to the inferior belly of 
the biceps muscle, also to the lower part of the vastus externus, is dis- 
tributed on the outer condyle of the femur, penetrates into the articular 
capsule, gives branches to all the ligaments of the keee, and communi- 
cates, by a very large anastomosing branch which proceeds across to 
the anterior face of the femoro-tibial articulation, on the common tendon 
of the extensors of the thigh, on one hand, both on the side and forward 
with the ascending branches of the external inferior articular artery on 
the other, on the median line and forward, with a similar branch of the 
internal superior articular artery. 

§ 1503 . The internal superior articular artery (Jl. articularis genu 
superior interna) varies more than the external and the middle in 
respect to its origin, for it not only forms a distinct trunk much more 
frequently than the latter, but it also not unfrequently, in fact almost 
normally, arises very high, as it sometimes comes from the superficial 
femoral artery, and then descends along the inner edge of the vastus 
jiternus muscle, to which it distributes ramifications. In this case, 
we find at the most normal place of its origin, a small artery, which is 
":ometimes a branch of a common trunk of the articular arteries, and 
sometimes arises directly from the popliteal artery, and anastomoses with 
the superior internal articular artery. When the origin of the latter is 
placed low, it goes a little from above downward, like the external, 
before it proceeds inward and forward, It divides into one or severa* 



ANGEIOLOGY. 331 

muscular branches, which go to the lower part of the vastus intemus 
muscle ; another median artery is situated lower, and passes behind 
this muscle and the common tendon of the extensors of the thigh, goes 
into ihe inner condyle of the femur and to the inner part of the ligaments 
of the knee ; finally, a third, which is superficial ; this proceeds on the 
anterior face of the femoro-tibial articulation, directly under the skin, 
anastomoses below with the branches of the internal inferior articular 
artery, and outwardly and transversely with the transverse branch of 
the external superior articular artery. 

Both the external and the internal superior articular arteries give off 
considerable and recurrent branches, which communicate with the 
branches of the deep and superficial femoral arteries. 

§ 1504. The middle articular artery {A. articularis genu media 
azygos) very rarely forms a distinct trunk, and is generally given off 
by the external superior articular artery. It goes forward and down- 
ward, penetrates from behind forward between the two condyles of the 
femur, and is distributed near the centre of the knee, in the femoro- 
tibial articulation, to the crucial ligaments, to the articular fat, to the 
posterior and middle part of the capsular ligament, and anastomoses 
with the branches of the inferior and also of the other two superior arti- 
cular arteries. 

§ 1505. Some small external and internal ramifications arise from 
the middle and inferior part of the popliteal artery and of its crural por- 
tion ; these are not constant and go to the lower part of the flexor 
muscles of the tibia and fibula. This portion then gives off the arteries 
of the gastrocnemii muscles and the inferior articular arteries. 

§ 1506. The arteries of the gastrocnemii muscles (A. gemellus) usu- 
ally arise, at least in part, above the inferior articular arteries and come 
from the posterior side of the popliteal artery. They are generally two, 
an external and an internal, one for each of the two upper heads of the 
triceps surae muscle. They rarely arise opposite each other. We fre- 
quently find also several other smaller gemellae arteries, which However 
do not always exist. These vessels furnish the blood to the plantaris 
muscle, which however sometimes receives a proper and distinct 
branch. 

§ 1507. The inferior articular arteries (A. articular es genu inferior es 
externa et interna) are usually two, an external and an internal, which 
generally form two distinct trunks. They arise from the anterior and 
lateral side of the popliteal artery, rarely at the same height. Some- 
times one and sometimes the other is higher. Generally they are of 
the same size. 

§ 1508. The external sends branches to the lower and middle head 
of the triceps surae muscle. These branches however sometimes arise, 
at least in part, from a special branch of the popliteal artery. The 
artery then, passing directly above the external head of the tibia, below 
!he external lateral ligament of the knee, and on the capsular ligament 
of the articulation, goes thus from behind forward. In its course it 



■y$2 1UPT1VE ANATOMY 

gives branches to the articular capsule, and anastomoses on one side 
by ascending lateral branches with the descending branches of the 
external superior articular artery, on the other by a large transverse 
branch, which passes above the lower part of the anterior face of the 
tendon of the extensors of the thigh, below the patella, with a similar 
transverse branch from the internal inferior articular artery. 

§ 1509. The internal usually proceeds a little downward, goes from 
behind forward and from without inward, below the internal head of 
the triceps surae muscle, directly surrounds the inner condyle of the 
tibia, gives numerous branches to the popliteus muscle, sends downward 
other branches, which anastomose on the internal face of the tibia with 
the recurrenl branches of the posterior tibial artery, gives also others, 
which are larger and transverse, which communicate directly above the 
insertion of the common tendon of the extensors of the thigh with the 
recurrent branches of the anterior tibial artery, and finally goes upward 
and forward on the external anterior face of the ligament of the patella, 
where it anastomoses by several ramifications with the internal superior 
and with the external inferior articular arteries. 

§ 1510. Besides these two inferior articular arteries, we sometimes 
find a middle articular artery {Jl. articidaris inferior media, s. azygos). 
which however arises oftener from the internal, and which penetrates 
from behind forward in the femoro-tibial articulation, on the median 
line, between the two condyles of the tibia. 

The popliteal artery generally gives off no other branches than those 
which have been described ; it is then the principal source of the anas- 
tomotic articular branches, by which, from the communication estab- 
lished between the upper and the posterior branches of the deep femoral 
artery, or between the inferior and recurrent branches of the arteries of 
the knee, the circulation of the blood may continue regularly in the leg, 
even when the superficial femoral and the popliteal arteries are oblite- 
rated. Thus these vessels are very much dilated after an operation for 
popliteal aneurism, where the superficial femoral and the popliteal 
arteries are obliterated. 



ARTICLE FOURTH. 

ARTERIES OF THE LEG. 

§ 1511. The popliteal artery generally, after passing an inch with- 
out giving off any branches except those which go from its lower part 
into the soleus or to the third head of the triceps sura? muscle, divides 
about an inch below the knee, very rarely higher and opposite the ar- 
ticulation, into two branches, called the tibial arteries {A. tibiales, s. 
cnemiales, Barclay). Of these two branches, the posterior is the larger, 
and may be considered from its direction as the continuation of the 
trunk, and is the common trunk of the posterior tibial and peroneal 



ANGEIOLOGY. 333 

arteries ; the anterior is smaller, separates from the trunk, and is the 
anterior tibial artery. The common posterior trunk is always larger 
than the anterior ; sometimes it exceeds it greatly in size, in which 
case the latter is arrested in the middle of the leg, and all the branches 
which it generally gives off then arise from the posterior tibial and from 
the peroneal artery. 

It sometimes divides very high. Thus, in a case observed by San- 
difort,(l) the crural artery divided directly below Poupart's ligament. 
Portal(2) has also found it to divide higher than usual. Ramsay(3) 
has seen it bifurcate, not in fact above the knee, but at least above the 
popliteus muscle ; the anterior tibial artery passed before this muscle, 
between it and the tibia, and was there compressed by him. 

I. ANTERIOR TIBIAL ARTERY. 

§ 1512. The anterior tibial artery {Jl. tibialis antica, s. rotularis)(4) 
describes a slightly acute angle to go forward above the upper edge of 
the interosseous membrane. On the anterior face of the leg it divides 
into two branches, the smaller of which is the ascending or recurrent 
branch ; the other is the continuation of the trunk ; the latter descends 
on the anterior face of the limb and is distributed on the tibial side of 
the leg and foot. 

§ 1513. The recurrent artery {A. rccurrens) gives branches to the 
tibialis posticus muscle, and is situated directly on the outer face of the 
upper extremity of the tibia ; it proceeds from below upward, to be dis- 
tributed partly in the head of the tibia, partly also to the external and 
lower part of the ligaments of the knee and the common tendon of the 
extensor muscles of the leg. It anastomoses with the inferior articular 
artery, and by means of it with the superior and likewise with the rami- 
fications of the femoral artery. We must place it among the accessory 
vessels of the lower extremity. 

§ 1514. The trunk of the anterior tibial artery descends on the an- 
terior face of the interosseous membrane, between the peroneus brevis 
muscle, the extensor digitorum communis longus, and the extensor 
longus pollicis proprius, and is covered by the two latter. It gives 
outward and inward numerous short and small branches, some of which 
are distributed in these muscles, while others pass through them to go 
into the peronei muscles and even to the skin. 

(1) Obs. anat. path., book iv. p. 97. The crural artery divides there into an anterior 
and posterior tibial artery, and we cannot admit that there is any doubt in regard to 
its high division into a superficial and a deep crural artery, since Sandifort expressly 
says, that on the left side the division occurred as usual in the calf of the leg. 

(2) Anat. med., vol. iv. p. 230. 

(3) Account of an unusual conformation of some muscles and vessels ; in the Edinb. 
Med. Journ., vol. viii. p. 283.— Barclay, loc. cit., p 263. 

(4) We describe this artery first, although from its direction and its small size it is 
not the continuation of the trunk, because it corresponds to the radial artery in its 
distribution. 



33-f DESCRIPTIVE ANATOLI?. 

When the posterior tibial or the peroneal artery is unusually large, 
the anterior tibial artery terminates on the back of the foot or in the leg. 
Sometimes it does not exist as a separate trunk, and is replaced in the 
leg by the perforating branches of the posterior tibial artery and on the 
back of the foot by the peroneal artery. In some subjects also it is ob- 
literated at the articulation of the foot, while above and below this part 
it admits the blood and is distributed as usual.(l) It generally fur- 
nishes the dorsal arteries of the foot and those of the large toe. 

Near the lower end of the leg, it gives off the two malleolar arteries 
{A. malleolar es), an external and an internal, which vary much in then- 
size and place of origin. 

§ 1515. The external malleolar artery (A. malleolaris externa) often 
arises a little higher than the internal, then descends from behind for- 
ward between the tibia and the fibula, resting directly on these bones and 
below the tendon of the peronei muscles, goes outward, expands on and 
in the external malleolus, frequently sends branches also to the anterior 
part of the lower end of the tibia, gives ramifications to the extensor 
hallucis brevis and abductor minimi digiti muscles, and anastomoses by 
a large branch with the recurrent branches of the tarsal artery on the 
anterior face of the articulation of the foot, and also with the anterior 
branches of the peroneal artery on the outside of the os calcis. This 
branch is constant, but it varies in size, and when large it partially or 
wholly gives off the dorsal artery of the foot. Sometimes it does not 
arise from the anterior tibial but from the peroneal artery, when the 
latter is unusually large. It is rarely given off by the peroneal artery, 
and arises still less frequently from the posterior tibial artery. 

§ 1516. The internal malleolar artery (A. malleolaris interna) usually 
arises a little below the preceding. It not unfrequently divides into 
several branches, which are given off from the anterior tibial artery, 
one on the tibia and the other on the tibio-tarsal articulation. 

It proceeds from without inward, under the tendons of the tibialis 
anticus and the extensor digitorum longus muscles, resting directly on 
the tibia and in the second case on the capsular ligament, arrives at 
the internal malleolus, distributes branches to this eminence, to the cap- 
sule of the articulation of the foot, to the astragalus, and anastomoses 
with the branches of the tarsal and posterior tibial arteries. 

When two internal malleolar arteries exist, they communicate with 
each other. 

This artery also sometimes arises, but more rarely than the prece- 
ding, from 'he peroneal or the posterior tibial artery. 

§ 1517. After giving off the malleolar arteries, the trunk of the an- 
terior tibial artery passes under the tendons of the extensor digitorum 
communis longus, on the outside of the extensor hallucis proprius, and 
Comes on the back of the foot, giving off right and left small branches, 

(1) This arrangement does not necessarily arise from the primary formation ; it 
may, as Burns correctly remarks (or Barclay, loc. cit., p. 293), I e accidental and be 
produced by compression. This ougnt also to be admitted in the second capp 



ANU£10L0GV. 385 

which go into the periosteum, the dorsal ligaments of the tarsus, and 
the tendons of the extensor and peroneus brevis muscles. In this place 
it is called the dorsal artery of the foot (Jl. pediaa). The latter is rarely 
the continuation of the trunk of the peroneal or of the posterior tibial 
artery. 

§ 1518. Internal and external branches arise from the dorsal artery 
of the foot. The latter are more numerous, larger, and more constant 
than the internal. We observe two particularly, the tarsal and the 
metatarsal artery. 

The tarsal artery (Jl. tarsea) arises from the outside of the dorsal 
artery of the foot, sometimes higher and sometimes lower on the back 
of the foot, even above the lower extremity of the tibia, in which case 
the external malleolar artery is very small ; this vessel is considerable, 
and its caliber almost equals that of the continuation of the trunk of the 
anterior tibial artery ; thus it would be more convenient to term it the 
external tarsal artery (Jl. tarsea externa), in opposition to another branch 
which corresponds to the inside. 

This tarsal artery goes transversely outward on the astragalus and 
os calcis, gives branches to these bones and also to the external part 
of the ligaments of the tibio-tarsal articulation and to the tarsus, sends 
off toward the external malleolus a large branch which anastomoses 
with the external malleolar artery (§ 1515), communicates on the out- 
side of the os calcis with the branches of the peroneal artery, gives off 
forward other branches which unite to those of the metatarsal artery, 
penetiates to the cuboid bone, to the posterior extremity of the fifth 
metatarsal bone, anastomoses also with the external plantar artery on 
the outer edge of the foot, and distributes branches to the extensor 
digitorum brevis and to the abductor minimi digiti muscles. 

§ 1519. Next comes the metatarsal artery (Jl. metatarsea), which 
also arises from the outside of the dorsal artery of the foot, and varies 
so much in regard to its origin that it is sometimes a branch of the 
tarsal artery, and sometimes arises several inches distant from it, and 
from the dorsal artery of the foot, directly behind the anterior edge 
of the tarsus. 

It is generally smaller than the preceding. Its direction, like that, 
is from within outward, assuming a course more transverse as it arises 
farther forward, and is always situated below the extensor digitorum 
brevis muscle. It is more or less evidently convex forward, and forms 
an arch, which is completed outwardly by the anastomosis constantly 
existing between it and the tarsal artery. This arch, on the outer edge 
of the tarsus, is changed by the smaller but constant branches of the 
tarsal artery into a vascular net-work, which covers most of the back 
of the foot. When this artery arises far backward, we usually find a 
second, which is smaller and proceeds on the anterior edge of the dorsal 
face of the tarsus, and which communicate with the posterior by very 
analogous longitudinal branches, which correspond in number and situ- 
ation to the three external interosseous spaces. This second artery is 
not so much a branch of the dorsal artery of the foot as the result of 



336 DESCRIPTIVE ANATOMY 

anastomoses between these longitudinal branches and the dorsal 
osseous arteries. 

Sometimes there are even three metatarsal arteries, a third existing 
between the two we have mentioned. 

A transverse arch, the convexity of which looks forward, conr 
stantly forms on the anterior part of the dorsal face of the tarsus or on 
the posterior part of the metatarsus. This arch contributes more or less 
but constantly with the posterior perforating arteries given off by the 
inferior tibial artery to form the dorsal interosseous arteries {A. inter- 
osse.ee dorsales), 

This vascular net- work is termed the dorsal arch of the tarsus (A, 
dorsalis tar sens). It varies much in extent and complexity. 

A dorsal interosseous artery proceeds in each space between two 
metatarsal bones. These arteries are always very large and some- 
times of an enormous caliber. They are four in number ; but the first 
or the most internal, comprised between the first and second metatarsal 
bones, is considered as the continuation of the trunk and is called very 
improperly the external dorsal artery of the large toe (A. hallucis 
dorsalis). 

All these dorsal interosseous arteries are similar in the following 
respects : 

1st. They anastomose by their posterior extremity with the posterior 
perforating arteries. 

2d. They communicate with the anterior perforating arteries by their 
anterior extremity, between the bases of the first phalanges of the toes. 

3d. They give off, outward and inward, branches, by which they 
anastomose with each other on the back of the tarsus, and which are 
distributed in the external interosseous muscles, the bones of the meta- 
tarsus, the abductor pollicis longus, and the skin of the dorsal face of 
the tarsus and of the toes. The branches which go to the toes, each 
of which receives at least two, the tibial and the peroneal, are called 
the dorsal arteries of the toes (A. digitales dorsales tibiales et peroneal). 

These superior interosseous arteries sometimes divide anteriorly into 
two branches, the tibial and the peroneal, each of which always goes 
to a different toe. 

From the outer part of the tarsal arch a branch usually arises, which 
is also connected with the superior interosseous arteries, but which goes 
to the abductor minimi digiti muscle, and sometimes arises from the 
fourth interosseous artery, or, according to the usual way of numbering 
them, from the third. This last also most generally gives off another 
branch to the fibular side of the little toe, the dorsal peroneal branch of 
this appendage, while itself gives off the dorsal tibial branch. 

Sometimes butrarely the second superior in terosseousarteiy, generally 
called the first, does not arise from the metatarsal artery, but from the 
continuation of the trunk of the dorsal artery of the foot, and then the 
latter corresponds more than usual to the middle of the dorsal face of 
'he tarsus. 



ANGEIOLOGY. 337 

§ 1520. The internal branches of the dorsal artery of the foot are 
smaller than the external. They are generally as numerous, but usually 
there is only one very large. That arises about the centre of the tarsus, 
a little before the anterior extremity of the astragalus. It is well called 
the internal tarsal artery (Jl. tarsea interna). 

This artery proceeds obliquely from without inward and from behind 
forward, distributes branches to the internal half of the bones of the 
tarsus and also to the first metatarsal bone, to part of the extensor digi- 
torum brevis and of the abductor pollicis pedis, and anastomoses with 
the dorsal artery of the back of the foot on the dorsal face of the tarsus, 
with the first interosseous artery, with the internal plantar artery on 
the inner edge of the foot, finally with the internal malleolar artery, and 
thus contributes to form the dorsal arch of the tarsus. 

§ 1521. The trunk of the dorsal artery of the foot divides, between 
the posterior extremities of the first and second metatarsal bones, into 
two branches : one is the continuation of the trunk, the first metatarsal 
artery, usually termed the dorsal artery of the great toe (Jl. dorsalis 
hallucis) ; the second, the deep anastomosing branch (R. anastomolicus 
profundus), passes directly to the sole of the foot, between the two 
bones, and forms with the external plantar artery the deep plantar arch 
(Jl. plantaris profundus), whence arise most of the plantar arteries of 
the toes (Jl. digitales plantar es). 

The dorsal artery of the large toe usually proceeds from behind for- 
ward on the back of the foot, along the external edge of the toe, and 
there divides into two branches, which become, one the common dorsal 
artery of the large toe, the other the dorsal tibial branch of the second 
toe. 

It anastomoses most generally either at its place of origin or by one 
of its two branches with the plantar artery of the large toe. 

II. POSTERIOR TIBIO-PERONEAL ARTERV. ' 

§ 1522. The common trunk of the posterior tibial andperoneal artery, 
called also the tibio -peroneal artery, or simply the posterior tibial artery 
(Jl. libio-peronea, s. tibialis postica, s. tibialis poplitea), descends verti- 
cally behind the interosseous membrane, covered by the heads of the 
peronei muscles, and generally, soon after the origin of the anterior 
tibial artery, gives off two considerable branches, an external and an 
internal. 

The internal branch sends off small twigs to the poplitcus muscle, 
penetrates principally into the tibia as the upper nutritious artery (Jl. 
nutritia tibicz superior), and gives off from behind forward, into the 
periosteum of this bone, ramifications which anastomose on its internal 
face with those of the inferior and internal articular artery (§ 1509). 

The external branch gives off ramuscules to the lower or middle 
head of the triceps surse muscle, proceeds below it, around the upper 
extremity of the fibula, sends off ramifications to the upper part of the 

Tn L tl 43 



338 DESCRIPTIVE ANATOMY. 

peroneus longus muscle, and anastomoses both with the anterior tibial 
(§ 1511) and with the descending branches of the external inferior 
articular artery. These two branches consequently contribute to en- 
large the system of the accessory vessels of the leg. 

§ 1523. After giving them off, the tibio-peroneal trunk, which sends 
only inconstant branches to the soleus muscle, divides generally from 
one to two inches below the origin of the anterior tibial artery into 
two branches, the peroneal artery and the posterior tibial artery. 

I. PERONEAL ARTERY. 

§ 1524. The peroneal artery (Jl. peroncea, s. fibularis) generally 
but not always arises at the place mentioned. Sometimes, but 
much more rarely, and only when the popliteal artery divides 
unusually high, it arises above, more frequently below, this point, 
and in the second case it is smaller in proportion as its origin 
is lower. Sometimes, in fact often, it does not exist, and it is re- 
placed by the branches which are successively given off from the 
posterior tibial artery. Independently of its point of origin it varies 
very much in respect to its volume, a circumstance in regard to which 
it increases and diminishes inversely with the anterior tibial artery. It 
is generally smaller than the two tibial arteries ; but sometimes when 
one of the latter is deficient it is much larger than usual. 

It descends on the posterior face of the interosseous ligament, covered 
by the soleus muscle, on the inside of the flexor longus digitorum com- 
munis muscle, gives its largest branches to these two muscles and 
also to the peronei, usually sends off, near the lower extremity of the 
leg, rather a large branch, which, passing under the posterior tibial 
artery, is called the posterior internal malleolar artery {A. malleolaris 
interna posterior) and goes to the internal malleolus, on the surface of 
which it frequently communicates with the anterior internal malleolar 
artery furnished by the anterior tibial artery (§ 1516), and terminates 
on the outer face and the tuberosity of the os calcis by ramuscules, 
which enter partly into this bone, and partly by large branches by which 
it anastomoses with the posterior tibial artery, thus forming the inferior 
plantar arch. 

§ 1525. At various heights of the leg, but generally toward its 
lower extremity, it gives off a branch which also varies much in size 
and which goes to the anterior face of the limb, passing between the 
two bones. When this branch is considerable it is termed the anterior 
peroneal artery {Jl. peroncea aiilcrior). It proceeds, near the surface, 
on the outer and anterior face of the leg, frequently descends to the 
external face of the tarsus, unites to the external malleolar artery, 
given off by the anterior tibial (§ 1515), concurs to form the dorsal 
arch of the tarsus, anastomoses with the branches of the external 
plantar artery, and distributes twigs to the tendons of the extensor 
digitorum communis, to the posterior part of the extensor minimi digiti 



ANGEIOLOGY. 339 

muscle, to the external malleolus, to the astragalus, and to the cuboid 
bone. 

This branch does not always arise from the peroneal artery ; 
it is then generally very small, and does not descend to the lower 
extremity of the leg or is entirely deficient. It is normally replaced 
by a branch of the anterior tibial given off by the external malleolar 
artery (§ 1515) less frequently, although more commonly than when 
it arises from the peroneal artery, it comes from the posterior tibial 
artery, and then it passes, at the us ual place, on the anterior face of the leg. 

The anterior peroneal artery much more rarely not only arises 
higher than usual, sometimes even not far from the middle of the ante- 
rior face of the leg, so that it sends off in this place ramifications to the 
peronei and to the extensor digitorum communis muscle, but it is also 
so large that it gives off the external malleolar artery ; and the dorsal 
artery of the foot is even the continuation of its trunk, and then the 
anterior tibial artery is very small, terminates on the back of the tarsus, 
and anastomoses with it. 

Not more frequently the peroneal artery, extends farther than 
usual in the sole of the foot, and gives off the external and the internal 
plantar arteries. We have before us only one specimen of this ano- 
maly. At the same time the anterior tibial artery is extremely small ; 
it stops at the middle of the leg, and all the branches it generally gives 
off below this point arise from the posterior tibial artery, which passes 
to the anterior face of the limb, about the level of its lower fourth. 

II. POSTERIOR TIBIAL ARTERY. 

§ 1526. The posterior tibial artery (Jl. tibialis postica) is generally 
much larger than the peroneal artery, but its direction varies more than 
that of the primitive trunk, and it proceeds slightly inward. It is 
generally a little larger than the anterior tibial artery and sometimes 
very much exceeds it in size. It descends, covered above by the third 
head of the triceps sur® muscle, between this muscle, the flexor longus 
digitorum communis and the'tibialis posticus, and is entirely loose at its 
lower part, being covered only by the crural aponeurosis and the skin 
and the posterior face of the tibia, on the inside of the tendo-Achillis. In 
its course it gives off posteriorly numerous small branches to the soleus 
muscle and the tendo-Achillis, and anteriorly to the tibialis posticus 
on flexor longus digitorum communis muscles. At the lower part of 
the leg it sends off several larger branches both outward and inward ; 
these anastomose frequently, on the two malleoli, with the internal 
and external malleolar arteries, given off by the anterior tibial artery. 

Theposterior tibial artery, proceeding between the tendons of the flexor 
longus digitorum communis and the tibialis posticus muscles, situated on 
its inside, and that of the extensor pollicis pedis on the outside, so that it 
passes on the latter, leaves the posterior face of the leg, and arrives at the 
sole of the foot, where it is situated on the posterior face of the os calcis. 



•540 DESCRIPTIVE AN ATOM \ 

Very rarely it passes from the posterior to the anterior face of the leg. 
thus becoming the dorsal artery of the foot. It most generally sends 
off, at the place where it enters the sole of the foot, a considerable 
branch, which goes into the os calcis and also into the lower extremity 
of the tendo-Achillis ; this branch anastomoses on the tubercle of the 
os calcis, before this tendon, with the final branches of the peroneal 
artery, and by means of them with the external malleolar artery ; thus 
a vascular plexus is formed which may be termed the inferior or plantar 
tarsal arch (rete, s. arcns tarsus plant oris). 

Not unfrequently another external and large branch goes to the 
posterior part of the abductor pollicis pedis musole. 

The posterior tibial artery then divides below the internal malleolus, 
about the centre of the inner face of the calcaneum, but a little behind 
it, into two branches, the external and internal plantar arteries. 

These two branches, and the two branches described previously, very 
rarely arise from the peroneal artery, which happens -when the poste- 
rior tibial artery replaces the lower portion of the anterior tibial artery 
(§ 1525). 

III. PLANTAR ARTERIES. 

I. INTERNAL PLANTAR ARTERY. 

§ 1527. The internal plantar artery (A. plantaris interna) is always 
smaller than the external, and varies in size less than the latter. It 
follows the direction of the trunk and goes forward, under the tendons 
of the flexor digitorum longus muscle, above the long head of the 
abductor pollicis, not far from the inner edge of the foot. In its course 
it sends superficial branches to the abductors and the flexor pollicis 
brevis, and to the flexor communis digitorum brevis, gives deep branches 
to the inner half of the plantar face of the ligamentous envelop of the 
tarsus, to the os calcis, to the astragalus, and to the scaphoid bone ; 
anastomoses, in several places above the inner edge of the foot, with 
the branches of the internal artery of the tarsus and of the dorsal artery 
of the foot, and gives off anteriorly, between the first and second 
toes, generally one, often also two, branches, which form the plantar 
artery of the large toe, and frequently anastomoses, by an external 
branch, with the deep plantar arch. 

II. EXTERNAL PLANTAR ARTERY. 

§ 1528. The external plantar artery {A. plantaris externa) is deeper 
than the internal. It varies in size more than this latter. It is often 
scarcely visible, and again is sometimes three times the size of the 
internal. These differences depend principally on those in the size of 
the dorsal artery of the foot (§ 1517), for there is always an inverse 
relation between the caliber of these two vessels. 

The external plantar artery immediately goes far outward. It pro- 
ceeds between the abductor pollicis pedis and the flexor digitorum 



ANGEIOLOGY. 341 

brevis below, and the accessory muscle above, toward the outer edge 
of the sole of the foot, where it extends forward, on the inner edge of 
the abductor minimi digiti muscle, gives branches to all the muscles 
mentioned, and anastomoses, by several branches which reascend 
above the outer edge of the foot, with the arteries of the tarsus and 
metatarsus. 

At the posterior extremity of the fifth metatarsal bone it goes inward, 
and gives off, either in this place or a little before, a considerable 
branch, ihe peroneal plantar artery of the fifth toe (A. digitalis plan- 
taris peronea digiti quinti), which goes forward on the flexor minimi 
digiti muscle, along the fibular edge of the toes to the anterior extre- 
mity, sends branches to its flexor muscle, to the third internal inter- 
osseous muscle and to the skin, and finally anastomoses, on the ungueal 
phalanx of the little toe, with the tibial branch. 

The deep or internal plantar artery then goes almost transversely 
forward and inward, between the internal interossei and the other 
muscles of the sole of the foot, and anastomosing with the deep anas- 
tomotic branch of the dorsal artery of the foot, between the first and 
second metatarsal bones, forms the deep plantar arch, which is con- 
cave backward and convex forward, and is situated very deeply on 
the posterior extremities of the metatarsal bones. 

III. PXANTAR ARCH. 

§ 1529. The digital arteries and the anterior and posterior perfo- 
rating arteries aris.e from the deep palmar arch, 

a. Digital arteries. 

§ 1530. The digital arteries (A. digitales) arise forward, from the 
convex part of the arch. 

Their general characters are, 

a. They are situated deeply in the sole of the foot, and proceed from 
behind forward, on the square belly of the flexor digitorum longus 
communis, and the transverse belly of the adductor hallucis. 

b. Between the posterior extremities of the toes they divide into two 
branches, which go one to the tibial side of the outer, the other to the 
peroneal side of the inner toe. 

c. The two branches unite on the ungueal phalanx, and also anas- 
tomose with each other and with the dorsal branches. 

d. They anastomose forward with the superior and inferior meta- 
tarsal arteries at their bifurcation. 

But they differ very much in regard to their origin. The deep arch 
most generally gives rise to the deep plantar arteries of the three outer 
and the peroneal branch of the second toe, less frequently to the tibial 
branch of this and the plantar branch of the large toe. 

The peroneal branch of the little toe often comes directly from the 
plantar arch, and even farther behind it. from the external plantar 



342 DESCRIPTIVE ANATOMY. 

artery (§ 1528), but it not unfrequently arises, by a common trunk, 
with the tibial branch of the fifth toe and the peroneal branch of the 
fourth. We have never observed that when this first digital artery 
gave off also the tibial branch, it was destined solely for the fifth toe, 
and did not proceed at the same time to the peroneal side of the fourth. 
Even when the peroneal branch of the fifth toe forms a distinct and 
separate trunk, it generally communicates by large anastomosing 
branches, both on the metatarsus and on the first phalanx of the toe, 
with the second digital artery, and the tibial branch of the fifth toe. 

The second digital artery when it does not form a trunk with the 
preceding, goes to the tibial side of the fifth toe and to the peroneal 
side of the fourth. 

Next comes the third, which goes to the tibial side of the fourth toe 
and to the fibular side of the third. Sometimes this artery is double 
as far as the arch from whence it arises to the anterior part of the 
metatarsus ; but its two trunks there unite in one, which soon divides 
into two branches, the tibial branch of the fourth and the peroneal branch 
of the third toe. This arrangement occurs particularly when the 
usual number of digital arteries is diminished in any manner whatever, 
as, for instance, by the union in one trunk of the peroneal branch of 
the fifth toe and of the two following branches. 

Next comes usually a fourth, which divides in the same manner for 
the second and third toes. 

The fifth constantly forms the tibial branch of the second toe. 
Sometimes, when the anterior tibial artery is much smaller and the 
posterior on the contrary is larger than usual, it forms the common 
plantar artery of the large toe, from whence the tibial branch of the 
second also arises. 

The plantar artery of the large toe and the tibial branch of the 
second vary the most in their origin and arrangement. 

This artery is generally the continuation and termination of the 
trunk of the dorsal artery of the foot, which comes to the first phalanx 
of the large toe, goes to its plantar face, and gives origin to all the 
plantar and dorsal branches of this toe, sending off first the peroneal 
dorsal branch, then the peroneal plantar branch, next the tibial plantar 
branch, and finally the tibial dorsal branch, which anastomose as 
usual. 

More rarely the continuation of the trunk of the dorsal artery of the 
foot divides, soon after giving off the deep anastomosing branch to the 
sole of the foot, into two branches, a superior, which becomes the com- 
mon trunk of the dorsal artery of the large toe and the tibial branch 
of the second ; an inferior, or the common trunk of the two plantar 
arteries of this toe, which bifurcates near the centre of the plantar face 
of the large toe, to give rise to two plantar branches. But we must 
remark that here we find a similarity between the anomaly and the 
normal or more common arrangement first described, since the two 



ANGEIOLOGY. 343 

branches communicate at the base of the first two toes by a large 
anastomosing branch. 

The superficial internal plantar artery given off by the posterior tibial 
artery always contributes to form the two plantar branches of the large 
toe and the inner branch of the second ; since it constantly anastomoses 
near the anterior extremity of the first metatarsal bone with the trunk 
of these branches, and thus forms the superficial plantar arch (arcua 
plantaris superficialis). 

When the anterior tibial artery is smaller than usual, it sometimes 
but not always gives off only the dorsal artery of the large toe ; some- 
times too it sends off in part the tibial artery of the second. On the 
contrary, the trunk from which the plantar branches of the large toe 
and the plantar branch of the second arise, the internal plantar artery, 
is unusually large, and is always increased by a branch, which varies 
in size ; this arises from the deep plantar arch, and communicates with 
it toward the extremity of the first metatarsal bone. 

Finally, sometimes but rarely all the arteries of the first and second toe 
arise only from the posterior tibial artery, particularly from the deep arch. 
The anterior tibial artery, which is very small, then terminates simply 
by a deep anastomosing branch in the deep plantar arch, and a large 
branch arises from the latter, which soon divides into two : one 
is deeper and larger, and is the continuation of the trunk ; it goes 
from behind forward on the first metatarsal bone, and is also enlarged 
by one or two branches arising from the internal plantar artery, which 
is also in this case unusually large, and bifurcates to give rise to the 
common plantar artery of the large toe and also to the tibial artery of 
the second ; the other is smaller and more superficial, ascends to the 
back of the foot between the first two metatarsal bones, gives off the 
dorsal branches of the large toe, and becomes, with a second digital 
artery given off by the deep branch, the common trunk of the tibial 
branch of the third toe and of the peroneal branch of the second. 

b. Anterior perforating 1 arteries. 

§ 1531. The anterior perforating arteries (A. perforantes anteriores) 
arise on the anterior part of the deep plantar arch, sometimes between 
the digital arteries. They are small and go only to the interosseous 
muscles, to the transverse head of the adductor hallucis muscle, and 
the metatarsal bones. A part of its ramifications communicate anteriorly 
with the digital arteries and the dorsal artery of the foot. 

c. Posterior perforating arteries. 

§ 1532. The posterior perforating arteries {Ji. perforantes poste- 
riores) arise from me posterior and upper surface of the deep plantar 
arch. They give branches to the posterior part of the interosseous 
muscles, and also recurrent branches to the anterior part of the tarsal 



344 DESCRIPTIVE ANATOMY 

ligaments and bones, and passing through the posterior extremities 
of the interosseous spaces, come on the back of the foot, where they 
anastomose with the upper interosseous arteries. 

These arteries are generally small, and can be considered only as 
the anastomoses between the dorsal and plantar arches. However, 
as these latter and the dorsal interosseous arteries are generally much 
larger than their corresponding parts in the hand, the posterior perfo- 
rating arteries are sometimes unusually developed ; so that the trans- 
verse tarsal artery sen 's only small anastomosing branches to their 
posterior extremities, in the place where they appear on the back of 
the foot. But in this case they are not the only origin of the dorsal 
interosseous arteries, which arise also from the plantar arteries of the 
toes and are much larger than the common trunks of the digital arteries, 
and which give all the digital branches commonly arising from the 
anterior side of the deep arch. 

In this case the usual anterior branches of the plantar arch still 
exist, but they are merely branches for the deep muscles of the sole of 
the foot and the anterior perforating arteries ; so that they are as 
slightly developed as the dorsal interosseous arteries generally are. 

There are many degrees between this state of the dorsal interosseous 
arteries and the common one ; so that for instance many or all the 
dorsal interosseous arteries contribute equally to form the digital arteries, 
and thus the dorsal and plantar arteries have about the same size, 
although it does not necessarily follow that the dorsal interosseous 
arteries arise from the deep plantar arch, as in the anomaly described. 
On the contrary, they sometimes become unusually large, but are 
however only the branches of the dorsal arch. 



SECTION III. 

OF THE VEINS OF THE BODY. 

§ 1533. The veins of the body generally unite in three large trunks,^ 
which open into the right auricle (§1305), the large coronary vein of 
/he heart and the two venoi cavce. 

CHAPTER I. 

OF THE VEINS OF THE HEART. 

I. LARGE CORONARY VEIN. 

<j 1534. 'Vh& large coronary vein of the heart (vena coronaria maxima 
cordis) opens into the right auricle, on the left and lower side of the 
mteraitricular septum, a little way from the venous orifice of the right 



ANGEIOLOGV. 3<i„ 

ventricle. It rarely empties itself into the left subclavian vein, (1) in 
which case the veins of the body do not unite except in two large 
trunks. 

It arises from all the extent of the left ventricle by four or five consi- 
derable branches, which proceed downward from the summit to the 
base of the heart, and among which we observe three which are larger 
and longer than the rest. 

The upper branch follows the upper groove of the convex face of the 
heart, which marks the upper edge of the septum. The second pro- 
ceeds along its blunt edge, and the third near the inferior groove. 

The smallest branches, which do not descend as low as the pre- 
ceding, are situated between them. 

All correspond to ramifications of the arteries, and empty at right 
angles into the trunk of the coronary vein, which proceeds in the trans- 
verse groove between the left ventricle and left auricle, first downward, 
then from behind forward to the place where it opens into the right 
auricle. 

II. SMALL CORONARY VEIN OF THE HEART. 

§ 1535. The small coronary vein of the heart (V. coronaria cordis 
minor, s. Galeni) belongs principally to the right auricle. It arises 
from the summit of the heart, proceeds in the lower longitudinal groove, 
or a little to the right, along the posterior and inferior edge of the right 
ventricle, receives the branches which come on the lower face of this 
ventricle, and almost always empties into the preceding, directly behind 
its opening. It rarely opens into the auricle, a little before the large 
coronary vein. 

III. SMALL ANTERIOR VEINS OP THE HEART. 

§ 1536. Besides these two large veins, others also, which are smaller 
and may be termed the small anterior veins of the heart, arise from the 
anterior ventricle, from the aorta and the pulmonary artery, and open 
separately into the anterior part of the right auricle. They extend 
from the summit to the base of the heart, proceeding before and above 
the preceding. 

IV. SMALLEST VEJNS OF THE HEART. 

§ 1537. The smallest veins of the heart ( V. minimal cordis) convey 
the blood in every direction, even in the left half of the heart, but espe- 
cially into the right auricle, through the foramina of Thebesins (fora 
mina Thehesii). 

(1) Le Cab, in the Mem. de Vac. des sc, 1739, Hist., p. 62 

Vol, fT 44 



346 DESCRIPTIVE ANATOMl 

CHAPTER II. 

VEINS OF THE HEAD AND UPPER EXTREMITIES 

§ 1538. The veins of the head and of the upper extremities all unite 
in the descending vena-cava. 

ARTICLE FIRST. 

VEINS OP THE HEAD. 

§ 1539. The veins of the head are distinguished into the superficial 
or external and the deep or internal. The latter convey the blood from 
the brain ; the former return it from the other parts of the head. They 
terminate in two large trunks, the internal and the external jugular 
vein. 

I. SUPERFICIAL VEINS OF THE HEAD. 

§ 1540. Almost all the superficial or external veins of the head open 
into the external jugular vein. A very few of them accompany the 
arteries ; the largest of them however differ a little in their distribution 
from that of the large arterial branches to which they correspond. . 

Those which resume the blood from the tongue, the pharynx, the skin, 
and the superficial muscles of the face, finally, from the sides and from 
the posterior part of the skull, unite in two large trunks, an anterior 
and a posterior, which correspond, the former to the facial artery 
(§ 1351), the latter to that part of the external caroiid artery which is 
above the facial artery, and to its outer termination, or to the temporal 
artery (§ 1358). . These two trunks unite to form one, which is short 
and corresponds to most of the external carotid artery, and is called the 
common trunk of the superficial veins of the head (truncus communis 
venarum capitis superficialium), or rather the anterior cephalic vein ( V. 
cephalica anterior). 

A. FACIAL VEIN, OR ANTERIOR BRANCH OF THE ANTERIOR VEIN OF 
THE HEAD. 

§ 1541. The anterior trunk of the veins of the head, the facial vein , 
the anterior and internal facial vein (R. venm cephalica anierioris an- 
ticus, s. V. facialis anterior, Walter) is formed by the veins of the an- 
terior and much the larger part of the face. 

It follows the direction of the facial artery, but is situated more be- 
hind than this vessel, and as it is less tortuous, it is also some distance 
from it 



AjSGEIOLOui 34' 



Regarded from above downward, according to the course of the 
«dood, this vein arises gradually by the union of the following branches : 

The upper branches are two in number, an anterior and internal 
and a posterior and external. The first is called the supra-orbitar and 
the second the frontal vein. 



I. SUPRA-OHBITAR VEIN. 



§ 1542. The supra-orbitar vein ( V. supra-orbitalis) is situated below 
the frontalis muscle, proceeds transversely along the upper edge of the 
orbit, anastomoses externally with the frontal branch of the temporal 
vein, and arises from several venous twigs, which come from the orbi- 
cularis palpebrarum, the corrugator supercilii, and the frontalis muscles. 



II. FRONTAL VSIN, 



§ 1543. The frontal vein (V. frontalis) arises, 

1st. From the branches which anastomose with the final anterior 
branches of the temporal vein and also with the synonymous branches 
of the opposite side, form thus a very complex vascular net-work on the 
frontal region, and come from the frontalis muscle, from the skin, and 
the frontal bone. The trunk formed by the union of these branches 
which often unites, at the lower part of the squamous portion of the 
frontal bone, with the synonymous trunk of the opposite side, by a large 
anastomosis, and frequently forms a median branch. 

2d. From an inferior branch, the superior dorsal vein of the nose 
(V. dorsi nasi superior), which, after anastomosing very frequently 
with the inferior dorsal artery of the nose, ascends and unites with the 
superior branch, which we shall describe. 



III. INFERIOR NASAL VEINS. 



§ 1544. The supraorbital and frontal veins unite in a common 
trunk in the inner angle of the eye, which descends along the nose 
directly below the skin. 

This trunk receives from before backward and from below upward, 
below the inner angle of the eye, first, the inferior dorsal vein of the 
nose (V. dorsi nasi inferior), then the upper anterior vein of the nose 
(V. nasalis anterior superior), afterward the lower anterior vein of the 
nose (V. nasalis anterior inferior), which frequently anastomose 
together, and with the upper dorsal vein of the nose. 



IV. CORONARY VEIN OF THE UPPER LIP. 



^ 154G. The trunk of the facial vein next receives, as high as the 
ala of the nose, the coronary vein of the upper lip, which often forms a 
common trunk with the anterior and inferior nasal artery, and which 
frequently anastomoses with it 



348 DESCRIPTIVE ANATOM-, 



V. LOW Eli INTERNAL PALPEBRAL VEIN 



§ 1546. The facial vein receives at its upper pari, opposite tin 
anterior and inferior nasal artery, the internal and inferior palpebral 
vein {V. palpebralis inferior interna). This vein is situated in the 
lower eyelid, between the skin and the orbicularis muscle ; it forms a 
very complex network which anastomoses externally with the upper 
palpebral vein, given off by the temporal vein (§ 1551), and with the 
external palpebral vein. 



VI. LOWER INTERNAL PALPEARAL VEIN. 



§ 1547. The external inferior palpebral vein (V. palpebralis externa 
inferior) descends directly under the skin, along the external edge of 
the orbicularis muscle, anastomoses within with the upper external 
palpebral vein furnished by the temporal vein, outward with the internal 
inferior palpebral vein, and, passing under the zygomaticus major mus- 
cle, before the malar bone, empties into the trunk of the facial vein 
much deeper than the preceding. 

VII. UPPER AND ANTERIOR INTERNAL MAXILLARV VEIN. 

§1548. Some distance below this external inferior palpebral vein 
the facial receives the upper and anterior internal maxillary vein ( V 
maxillaris interna anterior superior), which arises from the upper teeth 
and from the upper maxillary bone, from the posterior part of the nasal 
fossffi, and from the lower and anterior part of the orbit, by the follow- 
ing branches : 

1st. The upper alveolar vein (V. alveolaris superior). 

2d. The posterior nasal vein {V. nasalis posterior). 

3d. The anterior ophthalmic vein (V. ophthalmica superior) . 

§ 1549. From this point to the lower maxillary bone the facial vein 
receives principally, 

1st. The lower or external vein of the upper lip (V. labii superioris 
inferior, s. externa), which is much smaller than the internal. 

2d. The upper buccal vein (V. buccalis superior). 

3d. The middle labial vein ( V. labialis media), which is transverse, 
and empties itself into the trunk opposite the angle of the lips 

4th. The inferior labial vein (V. labialis inferior). 

5th. The submental vein (V. submentalis). 

§ 1550. It receives upward and outward, in its course, 

1st. The inferior buccal vein (V. buccalis inferior). 

2d. Three or four masseteric veins ( V. massetericae), a superior, a mid- 
dle, and an inferior, which arise from the substance of the masseter 
muscle, and form an extensive network on the surface of this muscle, 
which anastomoses with all the branches of the facial vein. 



ANGEIOLOGY. 349 

3d. The vein of the submaxillary gland (V. glanduloe maxillaris 
inferioris). 

B. COMMON TEMPORAL VEIN OR THE POSTERIOR BRANCH OF THE 
ANTERIOR VEIN OF THE HEAD. 

§ 1551. The common temporal vein, the posterior branch of the 
anterior vein of the head ( V. temporalis, s. R. primarius, vena: cephalicw 
anticce posticus, s. V. facialis posterior externa, Walter), is formed partly 
of superficial and partly of deep branches. The former arise princi- 
pally from the middle and lateral parts of the external face of the skull ; 
the latter come from the deep regions of the face. 

The following are the principal branches which unite below and 
backward to form the temporal vein : 

I. EXTERNAL UPPEB PALPEBRAL VEINS. 

§ 1552. One or two external upper palpebral veins (V. palbebralis 
superior externa) receive the blood from the tunica conjunctiva, the 
orbicularis palpebrarum, the skin of the upper eyelid, and frequently 
anastomose together, and also with the upper and lower external pal- 
pebral arteries, and the following. 

II. EXTERNAL SUPRAORBITAL VEIN. 

§ 1553. The external supraorbital vein (V. supraorbitaria externa) 
proceeds transversely over the upper edge of the orbit, under the orbi- 
cularis palpebrarum and the ligaments of the eyelids, and anastomoses 
with the external upper palpebral^veins (§ 1552). 



III. EXTERNAL FRONTAL VEIN. 



§ 1554. The external frontal vein (V. frontalis externa) arises from 
the skin of the forehead, from the frontalis muscle, from the periosteum 
of the frontal bone, and from this bone, anastomoses with the internal 
frontal vein (§ 1543) before, outward with the temporal vein, and 
communicates with the two or three preceding, at the outer extremity 
of the upper edge of the orbit. 



IV. DEEP TEMPORAL VEINS 



§ 1555. These three branches are situated directly under the skin, 
The trunk which is formed by them, or the deep temporal vein ( V. 
temporalis profunda), penetrates the aponeurotic envelop of the tem- 
poralis muscle, proceeds upward and backward under this aponeurosis, 
above the zygomatic arch, turns very frequently, receives in its course 
several branches which resume the blood from the temporalis muscle 
and the temporal bone, anastomoses frequently with those of the facial 



350 



DESCRIPTIVE ANATOM* 



vein, and communicates, before the external ear and above the 
poro-maxillary articulation, with the superficial temporal vein. 



V. SUPERFICIAL TEMPORAL VEIN. 



§ 1556. The superficial temporal vein (V. temporalis superficitdis) 
is generally smaller than the preceding, and is formed by an anterior 
and a posterior branch, which are both situated directly under the skin. 
The first arises from the sinciput, the second from the upper part of 
the occipital region, from the upper part of the ear. They most fre- 
quently join at a right angle, and form a small common trunk, which 
is soon united with the deep temporal vein. These two branches fre- 
quently anastomose with each other. The anterior also communi- 
cates with the branches of the external frontal vein, and the posterior 
with the occipital vein. 

VI. TRUNK OF THE TEMPORAL VEIN. 

§ 1557. The common trunk formed by the union of the deep and 
superficial temporal \ - eins, descends on the outer face of the malar 
bone, comes behind the ascending branch of the inferior maxillary bone, 
penetrates into the parotid gland, goes forward under the angle of the 
lower jaw, and anastomoses in this place with the facial vein or an 
terior branches of the veins of the head, and thus produces a short coin 
mon trunk. 

In this course it receives anterior, posterior, and internal branches 

VII. ANTERIOR BRANCHES. 

a. Anterior articular vein. 

§ 1558. The first anterior branch, counting from above downward, 
is the anterior articular vein (V. articularis anterior), which anasto 
moses very much with the deep temporal vein, and resumes the blood 
from the parts of the temporo-maxillary articulation. 

b. Transverse facial vein. 

§ 1559. The transverse facial vein (V. facialis transversa) empties 
into the trunk of the temporal vein, a little below the preceding : it is a 
considerable vessel, and generally arises by a superior and an inferior 
branch. 

The superior branch arises from around the temporo-maxillary ar- 
ticulation, and anastomoses with the anterior articular vein (§ 1558). 
and with the external infraorbital vein. 

The inferior branch arises from the superficial and the deep branch.ee 

The superficial branches carry the blood from the parotid gland, 
from the outer face of the masseter muscle, from the skin of this region, 
and from the parotid canal, and anastomose with the maxillary veins. 



ANGEIOLOGY. 35l 

The deep veins come from the pterygoideus externum muscle, and 
then go between the neck of the jaw and the posterior edge of the mas- 
seter muscle, where they communicate with the superficial branches. 



c. Parotid veins. 



§ 1560. The temporal trunk receives, much lower down and ante- 
riorly, some small parotid veins (V. parotides). 



VIII. POSTERIOR BRANCHES. 

a. Anterior articular veins. 

§ 1561. The posterior branches of the trunk of the temporal trunk, 
are, besides the following, the anterior auricular veins {V. auriculares 
anteriores), which arise from most of the concha of the ear. 

b. Internal and posterior maxillary vein. 

§ 1562. The deep branch (R. venai facialis posterioris profundus, 
Walter) corresponds mostly to the internal maxillary artery, furnished 
by the external carotid artery. We may then term it the internal 
posterior maxillary vein, to distinguish it from the anterior and superior 
maxillary vein (§ 1 548) . It is formed by one or two inferior maxillary 
veins, and by four or five deep temporal veins, proceeds inward, before 
the common temporal trunk, backward and downward, and empties 
itself at some distance from the angle of the jaw, into the posterior part 
of the common temporal vein, after giving off a considerable branch, 
which descends and anastomoses with the external jugular and the 
occipital veins. 

IX. LARYNGEAL VEIN. 

& 1563. The common trunk ot the anterior and posterior veins of 
the face corresponds to the external carotid artery, and usually re- 
ceives anteriorly a small branch, the laryngeal vein ( V. laryngea) which 
arises from the mucous membrane, and from the muscles of the larynx 
and of the hyoid bone. 

II. POSTERIOR CEPHALIC VEIN. 

6 1564. The posterior cephalic vein is formed principally by the 
veins of the brain, the tongue, and the pharynx. 

I. VEINS OF THE BRAIN. 

§ 1565 The veins of the brain may be divided into the external and 
the internal The large branches produced by their union are all in- 



352 DESCRIPTIVE ANATCMJV 

serted in the pia mater of the brain, and carry the blood into trunks 
called sinuses {sinus) which are formed by the inner membrane of the 
veins and by the dura mater. These trunks are partly surrounded by 
the bones of the skull, have principally transverse and longitudinal di- 
rections, communicate by several smaller sinuses, which have no con- 
stant direction, carry the blood backward and downward, and final]}' 
open into the posterior cephalic vein. . 

It seems to us more proper to describe the sinuses before we men- 
tion the veins of the head. 

a. Superior longitudinal sinus. 

§ 1566. The superior longitudinal sinus (sinus longitudinal is s, 
falciformis superior) is the longest sinus of the brain, and is situated on 
the median line. It occupies the convex edge of the falx of the cere- 
brum, directly under the frontal suture, the sagittal suture, and the 
upper half of the squamous portion of the occipital bone, from the cresla 
galli process of the ethmoid bone to the internal occipital protuberance. 
It has the form of a triangle, the base of which is turned upward, the 
apex downward ; it gradually enlarges from before backward very 
much, and terminates in the internal occipital protuberance, where it 
generally anastomoses with the right transverse sinus, in an irregular 
depression called the torcular herophili. We usually remark within a 
greater or less number of transverse cords (trabecular) : these extend 
from one side to the other, and are formed internally by the dura mater, 
externally by the internal membrane which is reflected upon the latter. 

The longitudinal sinus receives on each side, in its inferior and lateral 
parts, ten or twelve veins, which arise from the upper and external face 
and from the internal face of the brain, and which proceed in the pia 
mater and principally above the grooves between the circumvolutions. 

The veins of the outer and upper face are the largest and the most 
numerous. Before they empty into the upper longitudinal sinus, they 
receive those which ascend along its internal face. They always pro- 
ceed from before backward, increasing considerably in volume. 

Most of them, with the exception sometimes of the anterior, arrive 
at the longitudinal sinus at very acute angles and in a direction op- 
posite to that of the blood which passes through it. 

The posterior vein, also, before opening into the sinus, usually pro- 
ceeds some distance, frequently an inch between the fibres of the dura 
mater, which separate to receive them, and in the intervals of which 
they frequently curve very much. 

The curves of these posterior veins are also generally supplied with 
single more or less apparent valves, which the anterior do not possess, 
because as they open into the sinus more transversely, there is less 
danger of the regurgitation of the blood. 

The superior longitudinal sinus also receives, above, a considerable 
number of little veins, some of which come from the bones, while others 



ANGEIOLOGY. 353 

pass through the skull, and establish the communication between the 
internal venous system of the head, and the external branches of the 
temporal and facial veins. This results from the numerous ramuscules, 
and especiall v those of one or two larger veins, which passing through 
the parietal foramina (F. purietalia) carry the blood from within out- 
ward. 

Finally, the dura mater also gives venous branches, which empty 
into the upper and lateral parts of the superior loDgitudinal sinus. 

b. Inferior longitudinal sinus. 

§ 1567. The inferior longitudinal sinus (S. longitudinalis, s.falci- 
formis inferior, s. v.falcis inferior)^ 1 ) is much smaller than the superior. 
It extends from the beginning of the middle third of the falx of the 
cerebrum to its posterior extremity, where it anastomoses, generally 
dividing into two trunks, the inferior of which proceeds along the lowe'r 
and unattached edge of the cerebral falx, and empties itself into the 
anterior extremity of the fourth sinus, while the superior reascends be- 
tween the layers of the falx and penetrates downward into the centre 
of the same sinus. 

This sinus receives the veins of the falx, and in some rare cases some 
inferior veins of the internal face of the brain and of the corpus callosum. 

c. Right sinus. 

( § 1568. The fourth, right, or more properly the oblique sinus, the 
sinUs of the tentorium (8. rectus, s. perpendicidaris, s. quartus, s. obli- 
quus, s. tentorii), properly speaking, is only the posterior part of the 
preceding, but it is much larger than it. It descends obliquely from 
before backward, on the middle of the tentorium of the cerebellum, and 
occupies all the space between it and the union of the superior longi- 
tudinal sinus (§ 1566) with the transverse sinuses (§ 1571). 

It gradually becomes broader from before backward and is triangular. 
The transverse and oblique cords are more numerous in the anterior 
part than they are in the superior longitudinal sinus. 

Forward and upward it receives the inferior longitudinal sinus 
(§ 1567). The two large internal cerebral veins, or those of Galen 
( V. magncz Galeni), also open into its anterior extremity, below the 
anterior and inferior root of the inferior longitudinal sinus. 

d. Large internal sinus. 

§ 1569. The large internal sinus takes up the blood from the inner 
parts of the encephalon, and is formed principally on each side by the 

(1) Bichat, Anat. desc, vol. iv. p. 394. 
Vol. II. 45 



354 DESCRIPTIVE ANATOMY. 

union of two vessels, the choroid vein and the vein of the corpus 
striatum. 

The first proceeds in the choroid plexus, along the pes hippocampi, 
goes forward with the choroid plexus between the corpus striatum and 
the posterior large cerebral ganglion, and receives in the latter part of 
Us course numerous ramuscules of veins, which go from below upward, 
through the substance of the large cerebral ganglion, and extends to 
the anterior pillar of the fornix. 

The second is formed by small veins, which arise from the substance 
of the large anterior cerebral ganglion or the corpus striatum. It goes 
from behind forward, in ihe channel grooved between the corpus stria- 
tum and the thalami optici, until it anastomoses by its anterior extre- 
mity with the corresponding extremity of the choroid vein. 

It is sometimes double ; the posterior then passes above the thalami 
optici, and usually opens into the vein of Galen. 

The latter, arising from the point mentioned, proceeds directly from 
before backward, that is, in a direction contrary to that of the two 
branches which produce it, under the fornix, in the prolongation of the 
pia mater, which penetrates within the brain, and on that of the arach- 
noid membrane, which accompanies it. It generally receives, near its 
posterior extremity, the superior and anterior veins of the cerebellum. 
It opens into the anterior extremity of the right sinus, very near 
that of the opposite side, with which it sometimes unites to form 
a trunk of but slight extent, the direction of which it sometimes but not 
always crosses. 

e. Superior veins of the cerebellum. 

§ 1570. The fourth sinus also receives the superior veins of the cere- 
bellum, that is, the posterior, for the anterior empty in the veins of Galen. 

These veins, which, like the anterior, cross the transverse grooves of 
the cerebellum, go backward, and the anterior forward. Proceeding 
at first from before backward and then forward, they penetrate to the 
posterior part of the fourth sinus, and sometimes also into the com- 
mencement of the transverse sinus. 

f. Transverse or lateral sinuses. 

§ 1571. The transverse or lateral sinuses (S. transversi, s. laterales) 
are the largest, and descend on each side, in the transverse groove of 
the occipital bone, anastomose there with the fourth sinus and also with 
the upper longitudinal sinus, and terminate in the foramen lacerum, in 
the groove of the internal jugular vein. . 

That of the right side usually unites, but that of the left rarely, with 
the superior longitudinal sinus to form a short common trunk. Some- 
times also the posterior extremity of the latter passes directly between 
the two lateral sinuses. 



ANGEIOLOGY. 355 

That of the right side is most generally larger than that of the left. 

We not uncommonly observe that one or even both of them is divided 
in a greater or less part of its course, by a transverse layer, into a supe- 
rior and an inferior portion. 

When this layer exists through the whole extent of the lateral sinus, 
the latter is completely double. 

One of these two lateral sinuses is sometimes deficient. The superior 
longitudinal sinus then descends to the large occipital foramen, around 
which it turns to go to the posterior foramen lacerum. 

The lateral and inferior veins of the cerebrum and the inferior veins 
of the cerebellum open into the lateral sinus. 

The lateral and inferior veins of the cerebrum, the inferior cerebral 
veins, arise at nearly the centre of the skull, on the outside of the hemi- 
spheres, and usually unite in three trunks ; these are joined by a fourth, 
which comes from the lower face of the posterior lobe, separate from 
the cerebrum, go forward, and open separately from above downward at 
about the centre of each lateral sinus. 

The inferior veins of the cerebellum arise from the lower face of this 
organ, unite in two or three trunks, go backward and outward, and 
open from from below upward into the transverse sinus. 

g. Superior petrous sinu3. 

§ 1572. In the place where the transverse sinus touches the poste- 
rior extremity of the petrous portion of the temporal bone, and leaves 
its horizontal direction to go obliquely upward, we see detached, from 
its outside, a much narrower sinus, the superior petrous sinus (S.petro- 
sus superficialis, s. superior), which proceeds downward, inward, and 
forward, along the upper edge of the petrous portion of the temporal 
bone, where it terminates in the cavernous sinus, consequently unites 
this and the transverse sinus by anastomosis. 

h. Inferior petrous portion. 

§ 1573. The inferior petrous sinus (S. petrosus inferior, s. profun- 
dus) arises at the lower extremity of the transverse sinus, directly above 
the posterior foramen lacerum, from the anterior side of this sinus ; this 
is broader but shorter, and is situated between the anterior part of the 
petrous portion of the temporal bone, and the body of the occipital bone, 
and is almost wholly situated in a fossa hollowed from the latter bone, 
the posterior part of which is sometimes changed into a canal. This 
sinus proceeds from before backward and from without inward, which 
direction is preserved at its extremities better than in its centre ; it 
opens into the back part of the cavernous sinus, and establishes another 
large anastomosis be ween it and the transverse sinus. 



356 DESCRIPTIVE ANATOMY 



i. Cavernous sinus. 

§ 1574. The cavernous sinus (S. cavcrnosus), a considerable dilata- 
tion and of a very irregular form, is situated, on each side, on the lateral 
part of the body of the sphenoid bone. It anastomoses posteriori }>• 
with the posterior extremities of the two petrous sinuses, forward with 
the coronary sinus, and backward with the anterior occipital sinus. 

Its cavity has numerous soft reddish irregular filaments which inter- 
cross and are arranged in a. reticular form, from whence it takes its 
name. 

The internal carotid artery and the sixth pair of the cerebral nerves 
pass through it, covered by its inner membrane, which is reflected on 
them and unites them. 

It receives superiorly the anterior and middle inferior cerebral veins, 
forward the ophthalmic veins, downward, on the sides, the venous 
branches from the dura mater. 

k. Coronary sinus. 

§ 1575. The coronary sinus (S. circularise s. coronoideus) is gene- 
rally much broader anteriorly than posteriorly, and surrounds the pitu- 
itary gland. Its anterior or posterior portion is often deficient. It is 
sometimes also partly double, which depends on the existence of a 
transverse branch which passes below the gland. It receives the 
vein from the pituitary gland, and sometimes also the ophthalmic veins. 

/. Anterior occipital sinus. 

§ 1576. The anterior occipital sinus (S. occipitalis, s. basilaris 
anterior) extends transversely on the posterior face of the basilar pro- 
cess, from the union of the two petrous sinuses on each side, and the 
posterior extremities of the cavernous and coronary sinuses to the cor- 
responding point of the opposite side. It thus forms a considerable 
anastomosis between the sinuses of the two sides, and represents a 
second crown, situated below the preceding, which communicates 
below with the analagous sinuses of the vertebra. 

m. Posterior occipital sinus. 

§ 1557. The posterior occipital sinus (S. occipitalis, s. basilaris 
posterior) is sometimes single, sometimes and more frequently double 
In the latter case we find a right and a left. It extends from the inner 
extremity of the two transverse sinuses, and the external occipital pro- 
tuberance, along the posterior edge of the circumference of the lame 
occipital foramen, encircles the posterior and the lateral portions of this 
foramen, and anastomoses in front with the lower extremity of the 



ANGEIOLOGY. 357 

transverse sinus ; so that it forms a greater or less anastomosis between 
the lower and the upper part of this sinus. 

It is sometimes double at its summit and single in the centre, but it 
always divides very high up, above the occipital foramen, into a right 
and a left portion. It is generally not very large ; but it is frequently 
broad, and then the transverse sinus is smaller in a direct ratio. 

It sometimes but not very often replaces this sinus either on one or 
both sides. 

In other subjects, on the contrary, we cannot trace it in the least. 

§ 1578. The transverse sinuses empty through the posterior foramen 
lacerum into a very short common trunk, which may be termed the 
internal and posterior cephalic vein, or the encephalic vein ( V. cephalica 
interna posterior, s. cephalica encephalica, s. cerebralis), and thus con- 
trast it, according to the' analogy of the arteries, to the external and 
anterior cephalic vein, or to the facial vein. 

This trunk is situated very deeply, and descends outside of the trunk 
of the internal carotid artery, on the inside of the posterior belly of the 
digastricus muscle. It extends from the posterior foramen lacerum to 
the upper edge of the larynx, where it anastomoses with the anterior 
cephalic vein. 

It receives anteriorly the pharyngeal and the lingual veins, which 
generally empty separately, although they often unite with each other 
and with the superior thyroid vein. 

II. PHARYNGEAL VEIN. 

§ 1579. The pharyngeal vein (V. pharyngea) descends on the pos- 
terior and lateral part of the pharynx, and anastomoses very frequently 
•with that of the opposite side. It is often double on one side ; in this 
case, one of the two most generally arises from the thyroid vein. 

III. LINGUAL VEIN. 

§ 1580. The lingual vein (V. linguaiis) arises from the end of the 
tongue, enters between the mylo-hyoideus muscle, the genio-glossu6 
muscle, and the submaxillary gland, proceeds along the upper edge of 
the hyoid bone, before the hyo-glossus muscle ; thus its direction is 
backward, and it opens into the internal cephalic vein, either by a 
common trunk with the preceding, or below it. 

III. INTERNAL JUGULAR VEIN. 

§ 1581. The anterior and posterior cephalic veins unite near the 
hyoid bone, to form the internal jugular vein (V. jugularis interna), 
which might be more properly termed by analogy with the arteries, the 
common cephalic vein (V. cephalica communis). This vessel descends 
almost perpendicularly on the anterior and lateral part of the neck, out- 



358 DESCRIPTIVE ANATOMY. 

side of the primitive carotid artery and the pneumo-gastric nerve, in- 
side of the sterno-cleido-mastoideus and the omohyoideus muscles, 
comes to the anterior extremity of the clavicle under whieh it passes 
and unites with the subclavian vein, to form the trunk of the innominata. 

I. SUPERIOR THYROID VEIN. 

§ 1582. In this course the internal jugular vein receives some dis- 
tance below the union of the external and internal cephalic veins, a 
vein sometimes single and sometimes double, which often forms a com- 
mon trunk with the pharyngeal and lingual veins, this is called the 
superior thyroid vein ( V. thyroidea superior) : it corresponds exactly in 
its distribution to the artery of this name, but differs from it very con- 
stantly in its termination. It always empties into the common trunk 
of the external and internal cephalic veins. It not unfrequently divides, 
some distance from its insertion, into an upper and a lower branch, one 
of which ascends and the other descends. The superior thyroid artery, 
however, sometimes imitates the vein in this respect, and this anomaly 
frequently occurs, because it resembles the normal form of the vein. 

II. INFERIOR THYROID VEIN. 

§ 1583. The internal jugular vein also receives in its course, one or 
two inferior or middle thyroid veins ( V. thyroidece mediae, s. inferiores, 
s. descendentes), which arise from the outside of the lower half of the 
thyroid vein and empty higher or lower into it. 

This formation is remarkable also, as the superior or the inferior thy- 
roid artery sometimes partially or wholly arises on one or both sides, 
from the common trunk of the carotid arteries, and consequently re- 
sembles the normal arrangement of the veins. 

IV. EXTERNAL JUGULAR VEIN. 

§ 1584. The external jugular vein (V. jugularis externa) is much 
smaller than the internal, and forms the superficial or cutaneous vein 
which corresponds to the latter. It arises as high as the angle of the 
lower jaw, from the back side of the internal, goes outward under the 
parotid gland, and receives first in this place the posterior auricular 
vein ( V. auricidaris posterior), and then descends vertically between 
the platysma myoides and the sterno-cleido-mastoideus muscles, crosses 
the direction of the latter, and is placed on the inside of the omo- 
hyoideus muscle. Its lower portion corresponds to the inside of the 
sterno-cleido-mastoideus muscle, and is much deeper than the superior. 
It opens into the subclavian vein outside of the internal jugular vein. 
In order to this, it generally passes on the inside of the clavicle, but it 
is also sometimes reflected on this bone, from without inward. 



ANGEIOLOGY. 359 

Its lower extremity is often divided into two branches which ascend 
more or less high. 

Not unfrequently that part of its upper extremity which we have 
oefore mentioned as being that by which it arises from the internal 
jugular vein, is only a small' anastomotic branch, and the external 
jugular vein is so large above this point, that it receives the common 
trunk of the temporal vein and of the posterior internal maxillary vein, 
which does not enter as usual into the anterior cephalic vein. 

I. SUPERIOR SUPERFICIAL OCCIPITAL VEIN. 

§ 1585. The external jugular vein receives a little way below the in- 
ferior posterior auricular vein (§ 1584) the superior superficial occipital 
vein (V. occipitalis superficialis superior), which descends between the 
skin and the occipitalis muscle. 

Next come some deeper branches, which arise from the lateral and 
posterior muscles of the neck. 

II. INFERIOR SUPERFICIAL OCCIPITAL VEIN. 

§ 1586. The inferior superficial occipital vein (V. occipitalis super- 
ficialis superior) arises behind the superior, between the trapezius and 
the splenius muscle, some distance behind the external jugular vein, 
descends and empties into the latter at the lower part of the neck. 

III. POSTERIOR AND SUPERIOR SCAPULAR VEINS. 

§ 1587. Below, the external jugular vein receives posteriorly, the 
superior and the posterior scapular veins which accompany the arteries 
of the same name, and anastomose together and with the cephalic vein 
of the arm. 

IV. ANTERIOR CUTANEOUS VEINS. 

§ 1588. Before, it receives the anterior cutaneous veins of the neck, 
distinguished into the upper, the middle, and the lower. These veins 
arise from the skin and the anterior muscles of the neck, and frequent- 
ly anastomose above with the inferior branches of the facial veins. 



ARTICLE SECOND. 

VEINS OP THE UPPER EXTREMITIES. 

§ 1589. The blood of the upper extremities returns to the heart by 
the deep and the superficial veins. 



360 DESCRIPTIVE ANATOMY. 



I. DEEP VEINS. 

§ 1590. The deep veins follow the arteries of the same name, each 
of which is usually attended by two veins which proceed at its sides. 

II. SUPERFICIAL VEINS. 

§ 1591. The superficial or the cutaneous veins are much larger than 
the preceding, and proceed under the skin, between it and the brachial 
aponeurosis. 

Their roots, or the digital veins, arise principally from the back of the 
fingers, where we find from six to eight branches, situated at the side of 
one another, which frequently anastomose together. These branches 
also receive the largest veins which proceed along the palmar face of 
the fingers, which, at the height of the second or the first phalanx, 
leave this face to go to the dorsal. 

We may refer these veins to two principal trunks, the radial vein, 
and the ulnar vein. 



t. CATANEOUSBADIALVEIN. 

§ 1592. The cataneous radial vein, or the brachial cephalic vein 
(V. brachialis radialis catanea s. cephalica), arises from the thumb and 
the index finger, and is called the cephalic vein of the thumb ( V. cepha- 
lica pollicis) proceeds on the back of the hand, in the space between 
the first two metacarpal bones, at first along the radial edge of the fore- 
arm, then along the anterior side of the arm, outside the biceps flexor 
muscle, passes between the pectoralis major and the deltoides muscle, 
and empties in the subclavian vein, below the clavicle. 

II. CUTANEOUS ULNAR VEIN. 

§ 1593. The cutaneous ulnar or basilic vein (V. brachialis cutanea 
ulnaris, s. basilica) arises from the dorsal face of the third finger, often 
also from all the space between the back of the index and that of the 
little finger, and forms, on the back of the hand, a considerable network, 
which anastomoses in front with the cephalic vein of the thumb. 
Sometimes, when it comes on the back of the carpus, it goes forward 
toward the radius, and anastomoses, from the lower extremity of the 
forearm, with the preceding, with which it always communicates on 
the anterior and posterior faces of the limb, by means of several large 
branches, which form a broad network. It almost always forms in 
the forearm the anterior cutaneous ulnar vein ( V. ulnaris cutanea ante- 
rior), and the posterior cutaneous ulnar vein ( V. ulnaris cutanea poste- 
rior), the latter being generally larger than the former. 



ANGEIOLOGY. 361 

After leaving the articulation of the elbow it ascends, under the bra- 
chial aponeurosis, on the inside of the arm, along the ulnar nerve which 
it covers, and empties into the lower extremity of the axillary vein. 

III. MEDIAN VEIN. 

§ 1594. The median vein (V. mediana) is a large branch which 
serves to anastomose the radial and ulnar veins and also the superficial 
and the deep veins of the arm. It is generally single, but is sometimes 
double ; its length varies, and it extends obliquely upward and back- 
ward, from the ulnar to the radial vein, as high as the flexor carpi 
ulnaris muscle. It generally sends one or more considerable branches, 
which anastomose with the anterior part of the deep brachial vein, 
or of the deep radial or ulnar vein. These branches are sometimes 
replaced by others of the cutaneous radial vein. The lower part 
of this vein is called the median cephalic, and its upper part the median 
basilic vein. 

Sometimes the median vein ascends on the anterior face of the fore- 
arm, between the cephalic and the basilic vein, with which it commu- 
nicates by numerous anastomoses ; it is generally termed the common 
median vein {V. mediana communis). 

III. AXILLARY VEIN. 

§ 1595. The axillary vein (V. axillaris) arises at the lower extre- 
mity of the axilla, from the union of the basilic with one of the brachial 
veins, most frequently the internal and posterior. It ascends directly 
before the axillary artery, receives in the centre of its course the second 
vein of the arm, the external thoracic and subscapular veins, finally 
comes under and behind the clavicle, and is called the subclavian vein 
when it reaches the upper extremity of the serratus magnus muscle. 

IV. SUBCLAVIAN VEIN. 

§ 1596. The term subclavian vein (V. subclavia) is usually applied 
to all that part of the system of the descending vena-cava which is 
included between the latter and the upper extremity of the axillary 
vein. Some anatomists, as Bichat, consider the upper part of the veins 
of the pectoral extremity, which extends to the scalenus anticus muscle, 
as also belonging to the axillary vein, and consider the subclavian vein 
as commencing only in this place, contrary to all analogy with the 
arrangement of the arteries. It would be more proper then to confine 
it to the external portion of this trunk, which extends from the upper 
extremity of the serratus posticus to the scalenus anticus muscle. 

This proper subclavian vein receives the external jugular vein, which 
then empties into it (§ 1584) from belo-sr upward. 

Vol. II. 46 



3G2 DESCRIPTIVE ANATOMV. 

ARTICLE THIRD. 

INNOMINATA VEIN. 

§ 1597. The innominata vein (V. anonyma) is generally known as 
the subclavian vein ; but it is more convenient to conform with the 
analogy of the arteries, and to apply to it the first term. It is formed 
on each side by the union of the internal and external jugular and 
the subclavian veins. The scalenus anticus muscle separates it from 
the corresponding artery ; it passes before this muscle while the artery 
proceeds behind it. 

The left innominata vein is nearly twice as long as the right. It 
goes almost transversely or at least very obliquely downward and to 
the right, directly before and above the arch of the aorta, and above 
the upper edge of the sternum, leaving the sternal extremity of the left 
clavicle. 

The right leaves the sternal extremity of the right clavicle, goes 
more vertically downward and to the left,, unites at an acute angle 
with that of the left side, above the cartilages of the first rib, and thus 
gives rise to the descending vena-cava. 

We may consider the inner third of the left subclavian vein as cor- 
responding to the upper part of the arch of the aorta. The trunk of 
the descending vena-cava represents the beginning of this latter artery. 
The innominata vein of the right side corresponds perfectly to the 
innominata artery. 

The innominata vein receives on each side the vertebral, the superior 
intercostal, the internal mammary, the superior diaphragmatic, the 
thymic, the superior cardiac, and the lowest thyroid veins. 

I. VERTEBRAL VEIN. 

§ 1598. The vertebral vein (V. vertebralis) accompanies the verte- 
bral artery, before which it is placed. It anastomoses above with the 
occipital sinus, in its course from above downward and inward, by 
intermediate branches, with the vertebral sinuses of the neck, resumes 
the blood of the deep muscles of the neck by external branches, and 
often divides, at its lower extremity, into two roots, of which the upper 
emerges with the vertebral artery, through the vertebral foramen of the 
sixth cervical vertebra, while the lower emerges from that of the 
seventh either alone or at least attended only by a small arterial 
vessel.(l) 

According toBichat, that of the right side passes before, and that of the 
left side behind the pneumo-gastric nerve and the subclavian artery. 

(1) Eustachius, Dc osaibus, in Opp.omn., p. 191. 



ANGEIOLOGY. 363 

But this arrangement is by no means general. At most, the inferior 
root of the right vertebral vein, which passes through the vertebral 
foramen of the seventh cervical vertebra, usually goes behind these 
parts. *■ 

II. SINUSES OF THE VERTEBRAL COLUMN. 

§ 1599. The sinuses of the vertebral column (S. columnar verle- 
bralis)(l) are situated on the posterior face of the bodies of the verte- 
bra, before the dura mater, are formed by two long lateral trunks and 
by numerous transverse anastomosing branches, which are not, like 
the sinuses of the skull, formed by the dura mater of the inner mem- 
brane of the veins, and which, instead of adhering intimately to the me- 
ningeal sinus, are retained between it and the bone by a loose cellular 
tissue. 

The two trunks descend on the two sides of the posterior face of the 
bodies of the vertebrae, empty principally into the vertebral vein, with 
which they continue through the anterior condyloid foramen of the 
basilar bone, empty also the blood into the anterior occipital sinus, with 
which they communicate at least by considerable anastomoses, con- 
tract very much on the intervertebral ligaments, especially in the 
lumbar region, diminish singularly in caliber at the sacrum, approach 
each other in this place, and arise by several minute branches from 
the fat which surrounds the dura mater. 

They anastomose together on each vertebra by several large tortuous 
transverse branches (circelli venosi). Hence each of these bones has 
a proper venous crown, similar to that at the base of the skull, and cor- 
responds finally to the whole venous system of the interior of the skull, 
and opens externally into the adjacent veins, between each pair of 
vertebrae. 

The two longitudinal trunks are also united at their inferior extre- 
mity by a large transverse posterior branch, which corresponds to the 
anterior transverse branch of the coronary sinus of the skull (§ 1575). 

These trunks anastomose outwardly with the posterior branches of 
the vertebral, intercostal, lumbar, and sacral veins, through the inter- 
vertebral foramina. The transverse branches receive anteriorly nume- 
rous branches, which come from the substance of the bodies of the 
vertebrae, and posteriorly those which arise from the dura mater. 

The branches which enter the external veins, which we have men- 
tioned first, carry outward the blood which the sinuses of the vertebral 
column have received from the dura mater and from the vertebra?. 

From this description it follows that each vertebra, consequently also 
each corresponding section of the spinal marrow, particularly in the 
early periods of life when the spinal cord occupies the whole vertebral 
column, has its proper venous system, and that all these systems 
anastomose together and form a chain of rings. 

(1) G. Breschet, Essai sur les vcines du rachis, Paris, 1819. 



364 DESCRIPTIVE ANATOMY 



III. SUPERIOR INTERCOSTAL VEIN. 



§ 1600. The superior intercostal vein (V. imtercostalis supremo) is 
almost as large as the azygos vein (§ 1605), is much larger on the left 
than on the right side, and is often only a branch of the vertebral vein. 
When it is distinct and separate from the latter, it empties from below 
upward into the trunk of the innominata. Its roots extend below the 
eighth rib. It arises from the intercostal spaces, the left lung, the left 
bronchial vein, the esophagus, the aorta, &c, and anastomoses by its 
lower branches with the right and left azygos veins, unites to the first, 
and always proceeds at the left side of the second. It is as much 
longer as the left azygos vein is shorter, and resembles the right azygos 
vein as the branches of anastomosis between it and the left are larger. 
It proceeds downward, along the vertebral column, behind the pleura. 
§ 1601. The internal mammary vein, the superior diaphragmatic 
vein, &c, correspond precisely to the arteries of the same names. The 
lowest thyroid vein alone differs. 

IV. LOWEST THYROID VEIN. 

§ 1602. The innominata veins receive from above downward, usually 
on the right and left, or at least on one side, the lowest thyroid vein ( V. 
thyroideaima). The right is nearer the outer extremity of the right 
innominata vein than the left is to that of its own ; and the latter almost 
corresponds to the median line, while the other is thrown still more to 
the right, although the latter arises from the left lobe of the thyroid 
gland. 

Its constant existence deserves attention, because the lowest thyroid 
artery, which is not common, is a repetition of it. 



CHAPTER III. 

TRUNK OF THE SUPERIOR VENA-CAVA. 

§ 1603. The superior or descending vena-cava ( V. cava superior, s. 
descendens) is formed by the union of the two innominata veins, a little 
above the arch of the aorta, near the cartilage of the first rib on the 
right side. Thence it descends to the upper and right part of the right 
ventricle. Its direction is nearly vertical, a little oblique however from 
right to left and from behind forward. It proceeds on the right side of 
the aorta, and it is inclosed for the space of about two inches in the sac 
of the pericardium. Its upper part is loose and covered on the right b}' 
the summit of the right lung, on the left by the aorta, backward by the 
right superior pulmonary vein, forward by the cartilage of the upper 
eighth rib of the right side. It is situated entirely on the right. 



ANGEIOLOGY. 



366 



§ 1604. This is its usual arrangement; but sometimes, although 
very rarely, we find two descending venee-cavae, and then the two 
trunks of the innominata vein are not united. We have before us two 
instances of this anomaly, which has been mentioned also by Bcehmer, ( 1 ) 
Murray,(2) and Niemeyer.(3) In this case the right descending vena- 
cava descends before the aorta, turns backward and outward around 
the left auricle, comes on the lower face of the heart, goes forward in 
the circular groove, reaches the light auricle, and opens into its lower 
and posterior part. 

This anomaly is very curious, on account of its analogy with what 
is seen in several mammalia and in several reptiles. 

CHAPTER IV, 

AZYGOS VEIN. 

§ 1605. The descending vena-cava receives no branch in the peri- 
cardium: at least it is extremely rare that the azygos vein empties into 
it within the pericardeal sac. (4) 

But directly after leaving the pericardium, it receives at its posterior 
part, the azygos vein {V. azygos, s. sine pari), which opens still more 
rarely into the right auricle than into that portion of the vena-cava en- 
veloped by the pericardium, and it more frequently opens into the vena- 
cava much higher than usual. 

This vessel forms a large anastomosis between the descending 
and the ascending vena-cava, for it arises from the latter by numerous 
branches, and empties into the former. 

It does not perfectly deserve its name, since we find on the left side 
also a vessel which corresponds to it, the small semi-azygos vein ( V, 
hemiazygos) : this latter does not however extend as high. 

In the cases where this vein is thought to be doubled,(5) there is no 
new and unusual trunk, but generally, only a simple change in respect 
to capacity. This second azygos vein, which always exists on the 
left side is only an extraordinary development of the left superior in- 
tercostal vein, which constantly anastomoses by considerable branches 
with the right and left azygos veins. In this case there is only a di- 
minution, a contraction of the branches which anastomose between the 
common left and the right azygos vein, and likewise between the latter 
and left superior intercostal vein, with a considerable increase of the left 
azygos vein, whence a trunk is formed which occupies the left side, but 
which always empties into the corresponding subclavian vein at the 
usual place. 



(1) De confluxu triarum venarum cavarum, ; Halle, 1763. 

(2) Neue Schwedische Abhandlungen, vol. ii. p. 286. 

(3) Defcetu puellari difformi, Halle, 1814. 

(4) Cheselden, Phil. Tr., No. 337. 

(5) See our Handbuck der pathologischen Anatomie, vol. ii. p. ii, p. 127. 



366 DESCRIPTIVE ANATOMY. 

We have sometimes observed, in a similar case, a very curious 
formation, the insertion of the right azygos vein much higher than 
usual, and once even in the trunk of the vena-innominata of the right 
side.(l) 

This greater development of the left azygos vein, and its union with 
the left upper intercostal vein in a common trunk are not rare, but the 
lateral insertion of this vessel is much less common ; here the right 
azygos vein empties into the left, which is much larger, and its trunk 
does not terminate in the descending vena-cava, but in the left sub- 
clavian vein. (2) 

The azygos vein arises below on the two sides, by considerable 
branches, either directly from the ascending vena-cava, or from the 
renal or the first lumbar veins, most generally by several of these 
vessels at once. 

The trunks formed by the union of these branches, the right and the 
left, the former of which is the proper, or rather the right azygos vein, 
and the latter the semi-azygos, or more properly the left azygos vein, 
pass, sometimes with the aorta through, its opening, sometimes more 
outwardly, through the diaphragm. 

The trunk of the right side proceeds forward and to the right on the 
side of the esophagus, before the right intercostal arteries, on the an- 
terior face of the vertebral column. It receives behind and on the right 
the ten or eleven inferior intercostal veins, of which the inferior as- 
cend, the central are transverse, and the superior descend. Two or 
three of the latter generally unite in a single trunk. They all proceed 
below and before the intercostal arteries. 

The right azygos vein receives anteriorly the esophageal and the 
right bronchial veins. 

It receives on the left side, and nearly upon the seventh or the eighth 
dorsal vertebra, the semi-azygos or the left azygos vein, which passes 
behind the thoracic canal and on the vertebral column to come to it, 
after receiving the five or six inferior intercostal veins. 

This left azygos vein is sometimes double ; when this is the case, 
another, which is superior and smaller, anastomoses with it, and empties 
into the right azygos vein, when the superior left intercostal vein is 
smaller than usual. 

The right azygos vein anastomoses, by transverse branches, on the 
anterior face of the bodies of the vertebrae, with the superior intercostal 
vein. 

Similar anastomoses exist also between it and the left trunk, so that 
the formation of the venous system on the anterior face of the bodies 
of the vertebrae resembles that on their posterior face. 

(1) Wrisberg has once observed the same thing (loc. cit., vol. i. p. 136.) This ar- 
rangement of the right azygo3 vein does not necessarily exist whenever the left is 
unusually developed. 

(2) We have seen this case once. Wrisberg is the only author (loc. cit.. obe. iii. 
p. 142-145) who mentions it. 



ANGEIOLOGY. 367 

CHAPTER V. 

VEINS OF THE LOWER EXTREMITIES. 

§ 1606. The veins of the lower extremities like those of the upper 
extremities, are divided into deep and superficial veins. 

I. DEEP VEINS. 

§ 1607. The deep veins which accompany the arteries, and with 
which they are closely connected on both sides, are double almost to 
the knee, but in such a manner that the two synynomous veins already 
unite with each other at some distance from their upper extremity. 
After leaving the ham they are single. 

•I. POPLITEAL VEIN. 

§ 1608. The popliteal vein (V. poplitea) is single, and arises from 
the union of the anterior and posterior tibial and fibular veins ; it is 
situated backward and a little on the outside of the popliteal artery. 
It is more superficial than this artery, and intimately adheres to its 
parietes. 

II. CRURAL VEIN. 

§ 1609. The superficial crural vein (V. femoralis superficialis), by 
which term the preceding vein is designated, after it passes through 
the tendon of the adductor magnus muscle, comes on the inside of the 
crural artery, which partly covers it ; it is then situated more deeply 
than this artery. 

III. DEEP CRURAL VEIN. 

§ 1610. The deep crural vein {V. femoralis profunda) is generally 
more superficial than the artery of the same name. 

IV. COMMON CRURAL VEIN. 

§ 1611. The superficial and the deep crural veins unite and give 
origin to the common crural vein (V. cruralis s. femoralis communis), 
which is situated more inward and backward, and consequently more 
deeply than the corresponding artery. It is placed on the inside of this 
vessel, and is separated from it by the crural nerve. It passes under 
the crural arch to enter the abdomen. 



368 DESCRIPTIVE ANATOMY. 



II. SUPERFICIAL VEINS. 

§ 1612. There are two superficial veins called the saphencz (V. 
saphence), which carry back the blood from the skin of the lower ex- 
tremities. They are distinguished into external and internal. 

I. INTERNAL SAPHENA VEIN. 

§ 1613. The internal saphena vein (V. saphena, s. saphena interna, 
s. magna, s. cephalica pedis) arises by a deep branch, situated 
below the layer of cellular substance, from most of the inside of 
the toes, like the superficial veins of the arm, and is composed on the 
back of the foot of several branches, which form a considerable net- 
work ; it proceeds forward and backward along the internal and upper 
part of the tarsus, passes from the internal malleolus to the internal and 
anterior part of the leg, thus comes behind the inner condyle of the 
femur, then goes to the inside of the thigh, ascends along its inferior 
part before the gracilis or the adductor longus muscle, passes through 
the fascia lata aponeurosis, about one inch below the crural arch, and 
empties outward and backward into the common crural vein. 

A second branch which is more superficial, and situated directly be- 
low the skin, arises from the inner and anterior part of the leg, some- 
times also only from the inside of the tibio-tarsal articulation, often 
anastomoses with the preceding in this place, ascends on the anterior 
internal side of the thigh, and unites with the preceding, directly below 
its confluence with the crural ^ein. There it receives the superficial 
internal crural vein, and also ' most of the external pudic and subcu- 
taneous abdominal veins, which descend outward to come to it. 

II. EXTERNAL SAPHENA VEIN. 

§ 1614. The external saphena vein (V. saphena externa) is much 
smaller than the internal with which it communicates at its origin. It 
arises on the outside of the back of the foot, goes backward and upward 
under the external malleolus, approaches the tendo Achillis, reaches 
the centre of the posterior part of the summit of the leg, is situated 
in the ham on the inside of the tibial nerve, and empties a little above 
into the popliteal vein. 

III. EXTERNAL ILIAC VEIN. 

§ 1615. The external iliac vein {V. iliaca externa,^, anterior) is the 
direct continuation of the common crural vein, (§ 1612) and ascends 
behind and on the inside of the external iliac artery and along the iliacus 
internus muscle. At its lower extremity it receives the epigastric and 
the circumflex iliac veins. 



ANGEIGLOGY. 



IV. HYPOGASTRIC VEIN. 



369 



§ 1616. The hypogastric vein (V. hypogaslrica, s. iliaca posterior, 
s. inferior) arises by branches which correspond to those of the hypo- 
gastric artery, from the external and internal parts of the pelvis, conse-